dana-farber cancer institute


Jimmy Carter’s Good News And The Ever-Brightening Outlook For Melanoma

Former President Jimmy Carter teaches Sunday School class at Maranatha Baptist Church on Aug. 23 in Plains, Georgia, soon after he announced he was bring treated for cancer. (David Goldman/AP)

Former President Jimmy Carter teaches Sunday School class at Maranatha Baptist Church on Aug. 23 in Plains, Georgia, soon after he announced he was bring treated for cancer. (David Goldman/AP)

In August, former President Jimmy Carter announced that he was being treated for melanoma, a skin cancer that had spread to his liver and brain. Now, Carter says that his latest brain scan shows no sign of cancer spots.

This is not necessarily a “cure,” but it’s hard to imagine a more striking illustration of recent progress on treating malignant melanoma, once considered an imminent death sentence.

We sought some perspective from Dr. Elizabeth Buchbinder, a melanoma specialist at the Dana-Farber Cancer Institute.

Jimmy Carter says there’s no cancer showing up on his MRI. What does that mean?

EB: It’s incredibly exciting. It basically means that the lesions that were seen there before have resolved or disappeared or whatever term you’d like to use. And so it’s a great response. It’s what we would call a complete response on imaging, which is really really excellent, obviously.

The issue becomes this: We have limits to what our imaging can see. So we never know that there’s no cancer anywhere. But we know that there is none we can detect, which is very exciting. So all the cancer that we could see previously is now no longer detectable.

What does that mean happened biologically?

Biologically, he had a couple things happen, because he got radiation, which damaged his cancer, and he got [the drug] Keytruda. And what the Keytruda did is it turned on the immune system to act against those tumors. So the immune system then attacks and basically gets rid of cancer cells. And so very likely his immune system got turned on, attacked those cancer cells, eradicated what was there, and hopefully is continuing to eradicate anything we can’t see, and it now recognizes the cancer as something that it needs to get rid of.

When you have a great response like this, is it likely to remain so great?

“We’re really seeing a lot of people who are living a long, long time with either minimally detectable or no detectable cancer.”

– Dr. Elizabeth Buchbinder

Very likely. With immune therapy in particular, and even going back to some of the earliest immune therapies that we have used, such as an older one called Interleukin 2 — when it’s used, if you have a complete response and no longer have any detectable cancer, the chances of that continuing are much much higher than if you just see a little bit of shrinkage, or some degree of shrinkage but can still detect cancer. So chances are very, very good that Jimmy Carter will continue to do well going forward and not have trouble with cancer in the future. We can never say 100 percent, but this is definitely a very good response.

I imagine you now need to throw a bit of cold water on all the people who will call and say ‘I want what he got.’ What would you say to those patients? Continue reading


Personalized Cancer Test Pinpoints Best Drug For Patients

By Alison Bruzek

Cancer, whether in the pancreas, the ovaries or the liver, can take on different characteristics and spread in different ways. That’s why, unfortunately, there’s no one-size-fits-all drug to help patients fight back.

But a new, quick test can personalize treatment and help oncologists choose which chemotherapy route to take.

The test, called Dynamic BH3 Profiling, quickly predicts whether or not a drug will work for a patient by first trying that drug on a tumor sample in the lab. A paper describing the method, which researchers say could become more widespread within a couple of years, was published in the journal Cell this week.

The idea echoes how we choose the most effective antibiotics, says study author Dr. Anthony Letai, a cancer researcher with the Dana-Farber Cancer Institute.

A new tool for predicting relapse in acute myelogenous leukemia (AML) was developed by Dr. Anthony Letai (Courtesy of Dana-Farber Cancer Institute)

A new tool for predicting relapse in acute myelogenous leukemia (AML) was developed by Dr. Anthony Letai (Courtesy of Dana-Farber Cancer Institute)

“When we’re trying to choose antibiotics for people … we simply isolate the bacteria that’s causing the problem and expose it to all the drugs that are available,” he says. Then researchers choose the drugs that best put a lid on the multiplying bacteria.

“That has operated for many, many decades,” Letai says, “so we thought, why not do that for cancer cells?”

Letai’s team isn’t the first to think of this strategy. “People have tried to do this kind of thing in years past but there have been a variety of advances in technology … that make it more feasible this time around,” says Levi Garraway, a cancer researcher at Dana-Farber who was not involved with the study.

What’s different about Letai’s work is its speed: It can quickly determine whether a drug, or combination of drugs, is working. The test looks not at when the tumor cells are dead, but rather when they’re beginning to die.

The ‘Death Switch’

The researchers found that there is a point of no return, a threshold of doom, when cells begin to die that is indicative of their actual death. The team looked at varying types of cancer cells (breast, lung, melanoma) and saw that there was essentially a death switch that when flipped on, ensured the cell’s destruction.

Examining if a cancer drug flipped this switch, instead of waiting to see if the cells would eventually die, allowed the researchers to know, in about 16 to 24 hours, which drugs were working. Continue reading

Rethinking Cancer Research Through ‘Exceptional Responder’ Patients

Grace Silva and her oncologist, Jochen Lorch (Photo: Sam Ogden, Dana-Farber Cancer Institute.)

Grace Silva and her oncologist, Jochen Lorch (Photo: Sam Ogden, Dana-Farber Cancer Institute.)

By Richard Knox

By all odds, Grace Silva should have died more than three years ago. Instead, this 58-year-old grandmother is helping scientists rethink cancer treatment and research.

Silva’s case, detailed in this week’s New England Journal of Medicine, is one of only three recently published accounts of what cancer doctors call “exceptional responses” to a drug called everolimus (brand name Afinitor).

It was approved two years ago to treat certain breast cancers and is also used against some kidney and pancreas tumors. A couple of months after Silva started taking the drug, her thyroid tumors, which had spread to her lungs, melted away to nearly nothing. That basically never happens with this aggressive tumor, known as anaplastic thyroid cancer. “It was a near-complete response,” says her oncologist at Dana-Farber Cancer Institute, Dr. Jochen Lorch. “That in itself is exceptional. When we saw it, it was one of the better days around here.”

Studying The Exceptions

More remarkable still, Silva’s tumor stopped growing for 18 months. We’ll come back to what happened after that. But first, you should understand this story isn’t about everolimus or any particular cancer drug. It’s about how cancer specialists are learning how cancer works at the most basic level — by studying exceptional responders like Grace Silva.

And to appreciate why her case is important, you need to know how researchers figured out why she was an exceptional responder. It’s partly due to a five-year-old technology called next generation sequencing. It’s a cheap and rapid way of spelling out the genetic code of, in this case, individual patients’ tumors. Researchers can then look for gene mutations that are driving the uncontrolled growth that is cancer.

Continue reading

Seeking Good News About Ovarian Cancer

(National Cancer Institute)

(National Cancer Institute)

Ovarian cancer is scary to begin with — hard to detect early and often fatal. It’s the worst-case scenario I imagine most often during any pelvic or abdominal weirdness. And last week brought word of disturbing findings, summed up in The New York Times as “widespread failure among doctors to follow clinical guidelines for treating ovarian cancer, which kills 15,000 women a year in this country.”

The study found that among women with advanced ovarian cancer, just 25% of those who received substandard care survived five years, compared to 35% of the women whose care conformed with the guidelines.

The Boston Globe’s Deb Kotz runs through the major points of the findings here, but for a couple of lingering questions I spoke with Dr. Ursula Matulonis, an expert on ovarian cancer at the Dana-Farber Cancer Institute. Our conversation, lightly edited:

CG: Through no marketing effort of its own, Dana-Farber has just gotten the best imaginable advertising for the sort of specialized cancer center it represents. But not everyone can be treated at Dana-Farber and Sloan-Kettering. Can we not advocate for ourselves or patients we love elsewhere?

Dr. Matulonis: I would say access to a comprehensive cancer center is exactly what you need. You don’t have to have all the care here, but you do need entry into a system where you have the expertise. That runs from the surgeon you see for advanced ovarian cancer, who makes the judgment, ‘Can I do up-front site reductive surgery at this moment or does this patient need chemotherapy first?’

What’s promising about ovarian cancer is that it’s getting the attention that breast cancer has been receiving for the past two decades

Post-surgery, pathology expertise is important. And then, obviously, the medical oncologist, that’s where I come in: ‘Are the chemo doses appropriate? Is the patient getting intraperitoneal chemotherapy or is that not the right treatment?’ That actually is very important and all patients with advanced ovarian cancer should have it as long as all visible cancer or close to it has been removed, because the study shows that if you don’t get that, your survival is worse. So that’s important.

I think women with ovarian cancer need to be advocates for themselves, and the problem is that the diagnosis can happen so quickly. Women need to understand what the symptoms are, and if they really do think they have ovarian cancer, they need to see specialists who deal with it every single day, because that can have an impact on their survival. It’s such a simple thing, access to care, but so important. Even if the cancer is not advanced, that’s important.

So does this study highlight a growing disparity between ‘have’ and ‘have not’ cancer treatment? I’ve been wondering if such gaps will grow as cancer care advances in its use of fancy genomic technology, analyzing the genes of various tumors and matching treatments to those genes… Continue reading

Preferential Treatment for Children’s Hospital and Dana-Farber? You Decide.

Just two paragraphs in a $130 million mid-year state spending bill are the latest lightning rod in the health care costs debate.

The bill creates an exemption for any patient who is “undergoing an active course of treatment (at Children’s Hospital Boston or Dana-Farber Cancer Institute) and is newly enrolled in a select or limited network plan.” Right now, patients with tiered health insurance must pay higher co-pays and deductibles to use these two “high cost” hospitals. The bill would waive additional charges for patients who are already receiving treatment at Children’s or Dana Farber.

Sparks are flying. Insurers worry that this exemption (although it sunsets in 2013) would set a precedent. High end hospitals, especially those with specialized care, don’t want to lose patients.

Governor Deval Patrick must now decide if he’ll sign the bill or send it back to the legislature for revisions. Continue reading

Dana-Farber: ‘How To Tell Your Boss You Have Cancer’

This still makes me burn. My friend’s brother was diagnosed with colon cancer. He told his bosses and heroically worked as best he could through his chemotherapy treatments, despite all the nausea and exhaustion. But he still got fired for underperforming.

He might have benefited from the advice posted here by Nancy Borstelmann, the director of patient and family support and education at the Dana-Farber Cancer Institute. In a post titled “How to tell your boss you have cancer,” she runs down recommended steps, from finding out what to expect from your treatment to deciding whom to tell at work. But because of my friend’s brother, I’d emphasize this:

Keep a record. Employers are usually very supportive of employees going through cancer treatment, but this isn’t true 100 percent of the time. It’s a good idea to keep track of discussions you have with your boss or human resources office. Hang on to copies of work reviews, emails or letters about your performance, or requests for accommodations. This documentation will be helpful if you need to take action to uphold your rights in the workplace.

A Step Toward Health Benefits Of Exercise In A Pill?

Bruce M. Spiegelman of Dana-Farber in his lab

We’re a long way from being able to bottle the myriad benefits of exercise, but a study just out in the journal Nature looks like a promising step in that direction. It describes the discovery of a naturally occurring hormone christened irisin — pronounced like the name “Iris” with an “in” tacked on the end — that is elevated during exercise in mice and humans.

Irisin appears to be a possible key to the positive effects of exercise on blood glucose and energy expenditure — and thus on Type 2 diabetes and obesity. And because it is naturally occurring, it could be tested in humans fairly soon, perhaps in a couple of years.

But before we get to the science, a word from the study’s senior author, Dr. Bruce Spiegelman of Harvard Medical School and the Dana-Farber Cancer Institute. To all the negativity-mongers (my phrase, not his) out there who will grumble (my verb, not his) that this discovery will just enable more slothfulness, and would be unnecessary if all those couch potatoes would just get off their butts and eat better, please consider:

“The last thing in the world we’re trying to do is substitute for diet and exercise,” Dr. Spiegelman said. But first of all, there are many people who can’t exercise, whether because of paralysis or age or illness, he said. Work on irisin could potentially help them.

Second, yes, everybody should exercise and eat right but they don’t. Obesity and diabetes are worldwide epidemics costing untold billions, he points out. If irisin proves able to help fight them, it could benefit all of us.

Our conversation, lightly edited:

So where did the name irisin come from?

Iris is the Greek messenger goddess who carried messages between humans on earth and the gods on Olympus. We didn’t want to name it for any specific function because we don’t know what all of those are going to be, and what the most important are going to be, so instead we named it for its messenger function.

So what did you already know, and what did you find out?  Continue reading

Should Children’s And Dana-Farber Get Special Tier Treatment?

Here’s a great behind-the-scenes look at how Children’s Hospital Boston and the Dana-Farber Cancer Institute have been fighting to keep fast-growing “tiered” insurance plans from putting them off-limits financially to patients who need their care.

Written by Gatehouse News Service’s Jon Chesto, the story points out how the insurance landscape has changed recently, with health plans introducing “tiered” coverage that generally requires much higher co-pays for higher priced hospitals:

“When Dana-Farber and Children’s found themselves boxed out of this new world order, they sought assistance from the state Division of Insurance. It was up to that state agency to figure out how to implement the cost-containment law. But representatives for the two hospitals say their pleas fell on deaf ears.
So they marched back to Beacon Hill, and found two well-connected supporters there: Rep. Steve Walsh of Lynn, co-chairman of the health care financing committee, and Rep. Ron Mariano of Quincy, the House majority leader.
Mariano and Walsh pushed legislation this fall that would have kept Dana-Farber, Children’s and Tufts Medical Center’s Floating Hospital for Children out of the top-priced tiers. Continue reading

Dana-Farber Expert: The ‘Wrong Message’ About Prostate Screening

Dr. Philip Kantoff

Dr. Philip Kantoff, a leading expert on prostate cancer, is not usually the outspoken public critic type. But this time is different.

The director of Dana-Farber’s Lank Center for Genitourinary Oncology, he is very publicly decrying a federal task force’s recent recommendation against routine prostate screening for healthy men. On the Dana-Farber Cancer Institute’s homepage, he puts it clearly: The panel’s report “is the wrong message.”

So what’s the right message? I asked to speak to him with a particular question in mind: Is “watchful waiting” — officially known as “active surveillance” — the central problem? That is, is the PSA screening test drawing federal fire and causing men to be over-treated for prostate cancer largely because it’s just so hard to be told you have cancer and not do something very interventionist about it? Would PSA screening be more acceptable to medical authorities if we stopped over-reacting to the results?

‘The PSA created a bunch of problems but it is a clear advance.’

But the issue is too complex to distill it down to one question. Here’s our conversation, lightly condensed. My takeaway from Dr. Kantoff’s explanations:

Turning thumbs down altogether on the PSA test would set prostate cancer treatment back 25 years. Instead, we need to refine how the test is used. Men with short life expectancies should not be screened at all; some men with elevated PSA levels should not get biopsies. And most of all, more men should opt for restrained ‘active surveillance,’ hard as it may be.

Q: On the Dana-Farber Web page, you say the latest recommendations on prostate screening are the wrong message. What’s the right message?

Let’s begin with a 3-minute overview:

The PSA [Prostate-Specific Antigen] test was developed around 20-plus years ago, and has been used widely in The United States, and it has allowed us to make the diagnosis probably 10 years earlier than before.

It therefore did two things: It pushed back the date of diagnosis — and the stage at the time of diagnosis — so that very few people presented with metastatic disease when they came in the door, as was the case prior to the advent of the PSA.

But at the same time it uncovered a lot of cancers that did not need to be diagnosed, that were non-lethal cancers. However, for quite a number of years in the United States, people treated everything that came their way.

The downsides Continue reading

Steve Jobs’ Cancer: Major New Progress, But Still Fatal

Why did Steve Jobs have to die? What do scientists still not know about the type of cancer that he had? What might have saved him? These were the plaintive questions swirling in my head this morning.

I put them to Dr. Matthew Kulke, director of the carcinoid and neuroendocrine tumor program at the Dana-Farber Cancer Institute. Our conversation is below, but here’s my takeaway:

In fact, there has been very good news in the past year about the rare type of tumor that affected Steve Jobs, a pancreatic neuroendocrine tumor. For the first time in a generation, there are new treatments available, ‘targeted’ therapies that differ from conventional chemotherapy. But like many other forms of cancer, the disease is still not curable once it has spread. So early detection is key, and there’s hope for improved targeted therapies in coming years.

Dr. Matthew Kulke: “I think the main point, and perhaps the good that can come out of all the publicity about Mr. Jobs, is in awareness of these tumors. Not everyone is aware of them, and early diagnosis and awareness could be very helpful in identifying people early, at which time they can still be cured. The other important point is that with recent developments, even for people where they have spread beyond the point where surgery is helpful, there are now effective treatments for the first time in decades.

‘This is still a fatal disease, even though people can often live for years with it right now.’

(Dr. Kulke said he could not discuss Steve Jobs’ treatment specifically.)

There are really two different types of cancer that can arise in the pancreas. The most common is what people know of as pancreatic cancer, and that is quite a challenging disease to treat. What Mr. Jobs had is a more unusual type of cancer, which is a pancreatic neuroendocrine tumor. And these tumors, we think, arise from the islet cells in the pancreas — the cells that make hormones. And they do behave in a different way from the more common type of pancreatic cancer.

How? Continue reading