Tag: Precision Medicine

A Meeting of the Minds in Prague

prague-aua-programLast week, approximately 100 of the leading experts in genitourinary (GU) cancer research and treatment converged in Prague in the Czech Republic for the 114th Annual American Urology Association (AUA) Meeting. The AUA’s mission is “to promote the highest standards of urological clinical care through education, research and in the formulation of health care policy.”

The AUA has over 22,000 members from across the country, and many of the Weill Cornell Medicine/NewYork-Presbyterian GU physicians serve as members of the New York chapter. At this year’s meeting, doctors David Nanus, Jim Hu, and Scott Tagawa were invited to present on the latest standards in screening and treatment for prostate, bladder and kidney cancers.

jim-hu_aua-prague-2016On Thursday, September 15th, Dr. Jim Hu spoke about the screening controversy surrounding the early detection of prostate cancer and how this influences present day practice and the medical care men are receiving. We have a number of different screening tools available to detect prostate cancer and distinguish between aggressive and non-aggressive sub-types. One of the most common and least invasive ways to screen for prostate cancer is through Prostate Specific Antigen (PSA) testing, but this is controversial because some argue that it leads to false positives, or the detection of cancers that are very slow growing and may never need treatment. Most physicians and scientists agree that PSA testing isn’t perfect, but research shows that it can be a very good screening indicator when used in conjunction with physical exams, biomarkers and imaging tools. In addition, analysis of a recent study demonstrated that surveillance remains an option for some men with little difference in 10-year survival in those that choose treatment with either surgery or radiation, though there are tradeoffs in terms of a higher likelihood of developing advanced cancer in those that avoid more aggressive treatment.

Later that day, Dr. Scott Tagawa provided an update on the impact of chemotherapy in treating prostate cancer – a modality that was once thought to be a treatment last-resort. Chemo is now a standard much earlier on during cancer care and people are living longer, and feeling better as a result. In particular, the earlier use of a short course of chemotherapy at the time that men initially present to the clinic with advance prostate cancer leads to a significant increase in survival combined with better overall quality of life in the longer-term. The two taxane chemotherapy drugs proven to be successful in prostate cancer are docetaxel and cabazitaxel, and the latest research on these drugs seeks to answer questions regarding for whom and when these treatments will be benefit. At Weill Cornell/NYP we are leading the field in this research and developing hi-tech biomarkers to determine sensitivity and resistance.

Dr. David Nanus presented on Friday and highlighted the latest advances in treating urothelial cancers of the kidney and bladder. After nearly three decades with no new FDA drug approvals for bladder cancer, in 2016 we witnessed great treatment advances for bladder cancer. With immunotherapy, chemotherapy and genomics, we’re now on the cusp of precision medicine. The combination of these approaches with novel treatments is improving the lives of many of our patients with advanced urothelial carcinoma. We are now able to offer complete tumor and germline (inherited) genomic analysis as part of research studies that in the near term will translate to selecting the optimal treatment strategy for each individual patient.

Moonshot Summit: Changing Cancer As We Know it

DAVID NANUS, MD

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Photo credit: Ira Fox

On June 29, Weill Cornell Medicine and NewYork-Presbyterian Hospital joined more than 270 institutions across the country in holding a Moonshot Summit. These summits were held in conjunction with Vice President Biden’s Moonshot initiative to fight cancer. On this national day of action, cancer experts throughout our institution, survivors, and advocates came together to share their ideas for increased collaboration and cures.

The summit conversation started with a constructive dialogue about clinical trials and the unfortunate fact that for many cancer types, the “standard of care” chemotherapies are not good enough. At Weill Cornell Medicine and NewYork-Presbyterian, immunotherapies and precision medicine are opening new doors in cancer treatment, but sadly not all patients currently have access to these types of cutting-edge treatments.

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A packed room at the Weill Cornell Medicine/NewYork-Presbyterian Hospital Cancer Moonshot Summit (photo credit: Ira Fox)

Clinical trials may have gotten a bad rap in the past, but they are a powerful tool to access innovative treatments. The speakers agreed that clinical trials should be easily accessible to all patients, but at times there are obstacles. These range from lengthy forms that deter enrollment, to bureaucracy that slows the timeline for opening new clinical trials, to disinterest and concerns about the treatments’ effectiveness. On a global scale, there has been a lack of adult participation in cancer clinical trials, while for children we actually see the opposite trend – very high enrollment. What can we learn from this information?

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(L-R) Dr. Gail Roboz and Dr. Susan Pannullo speaking at the Cancer Moonshot Summit (photo credit: Ira Fox)

One of my colleagues Dr. Gail Roboz wisely stated, “I always tell my patients, be afraid of the disease, not the treatment.” She’s right in that we need to reframe the conversation to focus on making strides in increasing cure rates through new research that leads to new treatment breakthroughs across disease states.

We also talked about access to care. Not all patients are able to get a correct diagnosis quickly. This can be due to a variety of reasons including a lack of access to specialists, living in a rural area, or financial limitations. By increasing government research funding, as well as making it easier for patients to reach quality care, we can remove some of these barriers nationally. If we increase the number of people who are diagnosed with cancer early on, we can increase the cure rates. Additionally, as a country, we need to provide comprehensive care for patients and families and always put the interests of patients first. This includes offering supportive services beyond just the best medical care.

I felt so empowered by my colleagues and our patients’ great ideas about how we can overcome the challenges we face in cancer care. The Cancer Moonshot initiative is giving high hopes to many and will help ultimately change the world of cancer care as our country stands together with common goals and a renewed commitment to collaboration. By bringing everyone together at an event like this, we hear diverse perspectives and glean new insights. The fight against this terrible disease truly unites us all.

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Photo credit: Ira Fox

Hi-Tech Blood Biomarker Signals When a Strategic Switch in Chemotherapy Will Benefit Prostate Cancer Patients

For men with metastatic prostate cancer that grows despite hormonal therapy (also referred to as castration-resistant prostate cancer), chemotherapy has been a mainstay. The class of chemotherapy that has consistently proved to improve survival for men with advanced prostate cancer is called “taxanes.”

Taxanes target microtubules, which are structures in cells that are involved in cell division, as well as the trafficking of important proteins. In prostate cancer, one of the main ways taxane chemotherapy works to kill the cancer cells involves blocking the movement of the androgen receptor (AR) along the microtubule “tracks” towards the cell nucleus, a mechanism we discovered here at Weill Cornell Medicine.

There are two taxanes FDA-approved to treat prostate cancer, docetaxel (brand name: Taxotere) and cabazitazel (brand name: Jevtana). While the drugs are similar, men whose tumors have grown despite taking one drug often respond to the other. The challenge for oncologists has been pinpointing when exactly to switch treatments.

ScottTagawa_ASCO2016_TAXYNERGYDr. Scott Tagawa presented exciting results from a phase II clinical trial at the 2016 American Society for Clinical Oncology (ASCO) annual meeting demonstrating the power of this treatment switch, and when to make the switch.

This research came to be because we thought that we might be able to increase the number of men who respond to taxane chemotherapy with an early assessment and by changing the drug for those who have a sub-optimal response. Simply put, those with no response or only an initial minor response had their drug changed at a much earlier time point then standard practice. This resulted in a higher response rate for the patients in the study.

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In the photos from a sub optimally responding patient, almost all of the androgen receptor (AR, labeled in green) is in the nucleus (indicated by the arrow which is overlayed in blue on the right), meaning that the taxane chemotherapy treatment was unable to block AR from moving to the nucleus and thus unable to kill the prostate cancer cells.

In addition, it’s very exciting that we can examine cancer cells from a simple blood test, a process also referred to as collecting circulating tumor cells or CTCs. This allows us to assess the ability of a drug to target the pathway in real time and to tell us whether there is a positive tumor response or resistance.

These circulating tumor cells provide an opportunity for real-time molecular analysis of taxane chemotherapy and at Weill Cornell Medicine we’ve pioneered a way to examine the AR pathway with a simple blood test.

To do this we use an extremely specialized technology that captures the very small fragments or rare circulating tumor cells on a “chip.” From this chip we are able to determine which cells are responding to treatment.

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In real time, we can see taxane chemotherapy kept the (green) AR out of the (blue) nucleus area in cells from a responding patient. 

In cancer care, we are always trying to maximize treatment response rates by targeting the right cells at the right time. This promising precision medicine approach offers us one more tool to better personalize treatment and improve outcomes.