Jefferson Cancer Researchers at ASCO

Bluemle KCC bldg 750x1100 IMG_3339The American Society of Clinical Oncology celebrated its 50th Annual Meeting was held in Chicago this year. As usual physician-scientists and others from Jefferson’s Kimmel Cancer Center attended this major scientific event where the latest cancer research is presented. Click on the links below to learn more about some of the Jefferson research that appeared at the ASCO meeting this year.

The benefits of liquid biopsy

The DNA of a tumor is an ever-changing landscape. The first alterations occur as a normal cell picks up DNA mutations that push it toward tumor transformation. Later, as a full-fledged cancer cell, the DNA expression patterns constantly change in order to ensure the cell survives and keeps proliferating. Many of the newer cancer drugs target particular genes that drive tumor growth. However, because cancers change which genes they turn on or off, it’s important to monitor a patients over the course of treatment.

To this end, Jefferson researchers have been working on a blood test that provides a snapshot of a patient’s cancer without a surgical biopsy. Laura Austin, MD, a fellow in Medical Oncology and Massimo Cristofanilli, MD, Director of the Jefferson Breast Care Center and colleagues tested how well this blood test for DNA captures the genetic changes in a patient’s tumor, and showed that the test was able to reveal new opportunities for treatment that were overlooked by standards methods .

The researchers looked at 18 patients with locally advanced or metastatic breast cancer, and tested for the circulating DNA in their blood for cancer-specific changes. The test revealed the tumor’s genetic signature – the alterations in the cancer’s gene expression patterns – giving four patients the opportunity to try gene-targeted therapies that hadn’t yet been prescribed to control tumor growth.

A serious skin rash associated with better outcomes

When patients develop a severe rash on their skin during treatment for head and neck cancer it may be good news.

About two thirds of head and neck cancer patients being treated with the chemoradiation plus the drug cetuximab develop a serious skin rash in response to treatment with ceuximab. The drug belongs to a class of medications that work by blocking a receptor called EGFR involved in the growth of cancer cells, and is used to treat a wide array of cancers including head and neck, colorectal and lung cancers.

In the current Radiation Therapy Oncology Group (RTOG) secondary analysis, being presented at this year’s American Society of Clinical Oncology (ASCO) meeting in Chicago, by Jefferson’s Voichita Bar-Ad, MD, an associate professor in the department of Radiation Oncology and colleagues, showed that patients who developed serious (Grade 2-4) Cetuximab-induced skin rash had a better tumor response to therapy and a longer overall survival rate compared to those who did not develop a skin  rash at all or developed only a mild Cetuximab-induced skin rash (Grade 0-1). The patients with severe rash also were less likely to develop distant metastases.

The work adds to a growing body of evidence that suggests the development of serious Cettuximab-induced skin rash may predict better tumor response to anticancer therapy and improve clinical outcomes overall.

Bagging excess pills

Senior adults are often seen by multiple doctors for many ailments, receiving pharmaceutical prescriptions (and non-prescription medications) from each. As a result, seniors can end up with bags of pills, some of which may not be necessary, others that could be dangerous when combined. The confusion can be increased even more when cancer treatments are added to the mix.

Previous studies looking at potentially inappropriate medications (or PIM) in senior adults usually asked patients to recall the medications they take, or relied on the medical record to assess medication use. These approaches, however, are likely to miss medications or include medication inaccuracies. To solve this problem, researchers at Jefferson had their senior oncology patients consult with a clinical pharmacist as part of Jefferson’s multidisciplinary integrated approach to senior cancer care.

The researchers, led by Jefferson’s Ginah Nightingale, PharmD, BCOP, Assistant Professor at Jefferson School of Pharmacy and Andrew Chapman, DO, Co-director, Senior Adult Oncology Center at the Kimmel Cancer Center at Jefferson, investigated three tools in the medical literature to evaluate the use of inappropriate medications and found that the prevalence of PIM use in our cohort was 51 percent. Associations with PIM use (versus no-PIM) were polypharmacy and increased comorbidities, specifically cardiovascular, gastrointestinal, neurologic, and psychiatric conditions. While the evaluation tools caught a high number of inappropriate medications, the researchers concluded that a modified PIM tool that integrates two evaluation tools called Beers and STOPP and considers cancer diagnosis, prognosis and cancer-related therapy is needed in this vulnerable population.

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