Phase I clinical trials of patients with advanced cancers indicate that testing their tumors for a cancer-promoting genetic mutation is feasible in clinical practice and could be used to guide treatment.

Early results also show promising signs of an improved response rate among patients treated with drugs that inhibit the molecular pathway that is switched on by a mutation in the PI3CA gene.

Filip Janku, M.D., a fellow in M. D. Anderson's Department of Investigational Cancer Therapeutics, presented new findings on the PI3CA gene this week at the a major conference in Boston - the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics.

Mutations in the gene turn on the PI3K-AKT-mTOR pathway, which is often abnormally activated in cancer cells.  

Of 117 tumors tested from people with various late-stage cancers, 14 had the mutation and 10 of those were treated with PI3K-AKT-mTOR inhibitors based on that genetic analysis. Four of those 10 had partial responses, a high rate for a Phase I clinical, yet Janku notes the trial numbers are too small to draw conclusions now.

"These results need to be confirmed in a larger number of patients," Janku says. "We will have that opportunity as we continue to offer PI3K screening to patients considering a phase I clinic trial."  So far, responses were observed in patients with endometrial cancer, ovarian cancer, and breast cancer.

The American Association for Cancer Research highlighted Janku's presentation in its news media program. The meeting is a combined effort of the AACR, the National Cancer Institute, and the European Organisation for Research and Treatment of Cancer.


Reprogramming Genes as Cancer Therapy

Jean-Pierre Issa, M.D., professor in the Department of Leukemia, and a leader in the field of epigenetics, discusses this very different approach to cancer therapy in a podcast from the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics.

"Cancer is as much an epigenetic disease as it is a genetic disease," Issa notes. Epigenetic factors cause changes of gene expression and cellular behavior in cancer that are quite apart from those caused by genetic mutations or damage. 

Issa studies these chemical influences on genes at the basic science level and has successfully translated his findings into the clinic. The podcast addresses the challenge of translational research as well as the case for epigenetic therapy.

Resources:

Read the News Release from AACR

November 18 Teleconferences and Podcast Recordings

If you're a caregiver, in the midst of your expanded role carrying intense emotions and challenges, it's vital that you learn to take care of yourself.

If you're a woman or a spouse or loved one of a woman -- and that likely covers most people we know -- you may be struggling with how to interpret some new guidelines on breast cancer screenings that were issued today by the U.S. Preventive Services Task Force. You're probably very surprised to read their recommendations to push back initial mammograms to age 50 and conduct follow-ups every two years.

Thanks to the efforts of the American Cancer Society, Komen for the Cure, Avon, many other advocacy groups and even M. D. Anderson's own Public Education Office, it's likely that most women and their physicians would answer "40 years old" to the question: At what age should you get your first mammogram? Furthermore, we'd expect to hear "every year" in response to the question of how often to have this test.

Based on practices in our Cancer Prevention Center and the risk-based guidelines for breast cancer screenings, M. D. Anderson is standing by those recommendations.  

If you're of average risk, M. D. Anderson recommends you get your first mammogram at age 40 and return every year after that for regular screenings. If you aren't sure how to assess your risk, we recommend setting up time with your physician.

"We believe the benefits of an annual mammogram outweigh the risks for women, starting at age 40," says Therese Bevers, M.D., professor and director of M. D. Anderson's Cancer Prevention Center.

M. D. Anderson has studied the effectiveness of breast cancer screening and M. D. Anderson faculty contributed to the modeling analyses used by the Preventive Services Task Force to make its recommendation.   

Ongoing dialog and research on this topic are very important in the lives of many women. We'll assess these findings and others in the annual evaluation of our guidelines in March 2010.

The task force, and M. D. Anderson, are united in our emphasis on developing risk-based,  specific breast cancer screening guidelines. We'll continue to seek evidence that benefits women by catching this disease in its earliest stages.

"Doctors need to have more discussion about the risks and limitations of breast cancer screening with patients so they can participate in decision-making," Bevers says. "There have been huge successes in teaching American women about the benefits of screening mammography, but women have not been educated about the limitations of screening -- which is why many women believe that there is no harm in screening and if one test is good, two tests are better and more frequent testing with both is the best."

Read more about this discussion on twitter hashtag - #mammogram40

http://tweetchat.com/room/mammogram40

Transcript from Houston Chronicle MedBlog Live Chat Event
 

By Deborah Thomas, Staff Writer

The M. D. Anderson Circle of Sisters program and the Center for Research on Minority Health helped sponsor a visit to M. D. Anderson for Native American women from the Alabama-Coushatta Reservation. During the visit the women received instruction on breast cancer prevention and free mammography screening. They also spent time learning about the role nutrition plays in cancer prevention, the importance of breast cancer screening, and easy ways to relieve stress and stay healthy.




Deborah Scott, of the Native American Health Care Coalition, says, "In the native community breast cancer is a big problem, because many women are diagnosed late." According to The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved, American Indian/Alaska Native women have the lowest incidence of breast cancer yet have the poorest five-year survival rates.

Event Sponsors:
National Center for Minority Health and Health Disparities (NCMHD)
Native American Health Coalition
M. D Anderson Health Disparities Research, Center for Research on Minority Health
M. D Anderson Mobile Mammography Program
M. D. Anderson Place of... Wellness

M. D. Anderson recently updated its cancer screening recommendations. While the new guidelines focus on a person's chances of developing cancer, they also reveal when screening may no longer necessary. 

What's great about screening exams are that they have the potential to find cancer at its earliest stage, when the disease is most likely to be cured. For most of us, the benefits of getting a cancer screening exam outweigh the risks. However, there are some who may not benefit from having these tests. Therese Bevers, M.D., professor in the Department of Clinical Cancer Prevention, explains more.



Visit our website to review our cancer screening guidelines. To make an appointment in the Cancer Prevention Center at M. D. Anderson for these and other preventative cancer screenings simply fill out our patient self referral form. 

Do you get tests to check for cancer, such as a mammogram or colonoscopy? What do you think about cancer screening?

In addition to her titles of vice president for nursing, chief nursing officer and chair of M. D. Anderson's new Department of Nursing, Barbara Summers, Ph.D., R.N., is now a Fellow in the prestigious American Academy of Nursing.

One of only two AAN fellows at M. D. Anderson and one of 1,500 nationally, Summers was inducted into the prestigious organization during a formal ceremony over the weekend in Atlanta. She was one of 97 new inductees into the academy, an organization that monitors and advances health care policy and develops solutions to challenges facing the nursing profession. Selection as a Fellow in AAN is considered nursing's highest honor.

Despite Summers' stellar career as a nurse executive, teacher, mentor, administrator, advocate and researcher, she says she thinks of herself primarily as an oncology nurse.

"Oncology nurses are the secret weapons in the war we are winning against cancer," Summers says. "They're the critical thinkers, the caring partners and the constants in every patient's personal journey, and it is my privilege every day to lead and work on their behalf -- and to be one of them."

Summers, who is from a family of nurses, is driven by not only her respect and love for nursing but the desire to build a culture that gives to all M. D. Anderson nurses the same inspiration, joy and reward that she reaped as an oncology nurse early in her career.

"Down deep with all of my leadership, advocacy and management experience, I'm still an oncology nurse at heart," she says. "To this day, I remember caring for a little boy who received a bone marrow transplant and the relationship I built with his family. It's an incredibly proud calling to be an oncology nurse, especially at M. D. Anderson."

Summers came to M. D. Anderson in 1997 as clinical administrative director of the hematology clinical program, one the institution's largest services. Leading up to her current position, she also has worked as associate vice president for clinical programs and vice president for outpatient services at M. D. Anderson.

Prior to coming to Houston, Summers was with the National Institutes of Health where she was manager of critical care. She has worked as a clinical nurse at hospitals in Virginia, Washington, D.C., and Maryland.

She earned her Ph.D. in health care administration, master's degree in oncology nursing and bachelor's degree in nursing from George Mason University. She has held faculty appointments at her alma mater as well as at Georgetown University and Catholic University.

One of Summers' goals at M. D. Anderson and as a recognized national advocate for the nursing profession is to continue to drive home the messages that nurses are invaluable resources to their health communities and that nursing has changed for the better in the last decade. Every day, Summers and her team strive "to build a community of exceptional nurses engaged in extraordinary practice," a theme that captures the essence of her goals for the department.

I've been an employee at M. D. Anderson Cancer Center for almost 10 years. Not long after I began working here, I learned about the well-woman exams given through the Cancer Prevention Center - a mammogram, a pap smear and a good ol' general going-over was included, along with the bonus of an official blue M. D. Anderson patient card. At that time, it seemed to me that this card might be a handy thing to have in my hip pocket - just in case, you know.

Really and truly, I never dreamed that it would be me who would become an "employee with cancer." Why on earth would something like that happen to a nice girl like me? I had no notion that it ever would, but sure enough, it did.

In truth, it wasn't that coveted blue card that got me in the doors of M. D. Anderson. It was just a simple call for an appointment. Rumor has it that it's impossible to become a patient in this cancer center, but I'm here to tell you that this isn't so.

If you have cancer, and I will always pray that this doesn't happen to you, M. D. Anderson is the place you want to be. M. D. Anderson is currently (and consistently) ranked by U.S. News & World Report as the No. 1 cancer center in the country - really in the world. M. D. Anderson knows all about cancer - the doctors, nurses and other staff here will give you the latest and greatest treatments available. Bottom line, you can count on M. D. Anderson.

I must be honest, my cancer journey has definitely been paved by my many friends here at the institution. But, it's an entirely different experience to walk through the front doors of Clark Clinic as a patient versus as an employee.

I'll never forget the first time I did that. I was greeted by a volunteer who I loved. She threw her arms out wide to hug me and said, "Ohhhhhhhh, Gail." I walked a few steps forward and ran into my favorite UT policeman, James. "Miss Gail, what's this I've been hearing about you?" he asked. Then, the other person in the elevator on the ride up to the Brain and Spine Clinic was another friend. My family was astonished and couldn't believe that I knew all of these people. M. D. Anderson is a huge place, you see.

But, if you want to know the truth, M. D. Anderson is a warm, caring family. The folks here usually take care of you like one of their own. Like I said before, brain cancer was never something that I expected to happen to me, but it's been a great way to expand my list of loved ones.

Renowned artist Peter Max will donate a custom portrait to benefit the Children's Art Project at M. D. Anderson Cancer Center.

Peter Max, who capitalized on the psychedelic '60s and is still painting today, loves to combine his passions for painting and astronomy. In November, he will jet his way to the Off the Wall Gallery in the Houston Galleria where a special selection of his recent works, "Colors of a Better World," will be on display.

Max, who was born in Germany, still finds himself fascinated by his original interest in the universe and astronomy. He explains that the comparison of the size of a person to the size of the earth is an incredible thought. "I'm just amazed at this universe and still wonder how it happened," he says.

However, a chance invitation to attend art school got in the way of his desire to be an astronomer. "I went to art school and got the bug," Max explains. However, his artwork is filled with suns and moons and stars, all astronomical images.

Based in New York City, Max says that he can't wait to get to work each morning and always hates to leave. Fortunately, he lives near his studio where he comes in daily to paint.

Along the way, Max also discovered his philanthropic side. To that end, he's donating the painting of a custom portrait to a lucky bidder in a silent auction at the Off the Wall Gallery. Bids may be placed at the Houston gallery beginning Saturday, Nov. 7, and continuing through Saturday, Nov. 14, at 8 p.m.

The winner of the portrait will be notified at the event or by phone on Monday, Nov. 16. All proceeds from this auction will go directly to the Children's Art Project at M. D. Anderson Cancer Center to help make life better for children with cancer. Through worldwide sales of young cancer patients' original artwork featured on seasonal note cards and gifts as well as through generous donations, the project has funded offerings from the Children's Cancer Hospital such as educational programs, college scholarships, summer camps, ski trips, the Child Life program and other exciting activities that benefit cancer patients and their families.

Don't miss this chance to see the recent work of Peter Max. Previews of the art begin Nov. 7 at the Off the Wall Gallery in the Houston Galleria. Max himself will be at the gallery on Saturday, Nov. 14, 6-9 p.m. and Sunday, Nov. 15, 1-4 p.m. The gallery would appreciate an RSVP, 713-871-0940, if you plan to come by.

The New York Times article by Gina Kolata -- Forty Years' War, A Place Where Cancer Is the Norm -- made my heart swell with pride to be part of the M. D. Anderson team and my eyes well with tears for those whose struggles she wrote about.

I think about the thousands of patients I have had the honor to care for over the last 30 years. I wish Kolata could have met my patient Dorothy.

Flashback to 1979, I was a new oncology nurse at M. D. Anderson when I met this 38-year-old, petite and strikingly beautiful brunette who had advanced cervical cancer. Her doctors at home told her that she had only one year to live.

Dorothy came to M. D. Anderson searching for treatment that would allow her to live to see her 10-year-old daughter graduate from high school. She entered a clinical trial receiving intra-arterial chemotherapy using a then-new drug named Cisplatin. Dorothy received this drug for four months. It wasn't for the weak of heart. She lost her hair, vomited and was exhausted for two weeks after the chemotherapy was completed. Just as she began to feel "normal," it was time for the next round of therapy. Then the treatment regimen was complete. 

For the next five years or so, I saw Dorothy when she returned for her doctor's visits. We'd share stories about our families while she anxiously awaited her test results. After her doctor would give her the results of yet another "clean" CT scan, she would give us a hug and huge sigh of relief.

Dorothy beat her cancer with what I think Kolata would call "unconventional treatment." For Dorothy, this was a clinical trial.  

Cancer eludes, suppresses or subverts the body's immune system to survive and grow. Scientists at M. D. Anderson have found that the helper T cell Th17 awakens the immune system to attack and destroy tumors with custom-made killer T cells. Professor of Immunology Chen Dong, Ph.D., and colleagues report their findings online today in the journal Immunity.  

Working with a mouse model of metastatic human melanoma tumors, the researchers show that the absence of Th17 led to virulent growth of melanoma in the lungs, while injecting Th17 cells prevented melanoma development and destroyed existing tumors. Th17 secretes the inflammatory protein interleukin-17 (Il-17), which launches the immune system response. 



"While there is much work to be done, these preclinical findings imply the possibility of taking a patient's Th17 cells, expanding them in the lab, and then re-infusing them as treatment," Dong says. Development of a vaccine to stimulate Th17 cells would be another possible application.

Dong is co-discoverer of Th17, one of only four known types of T helper cells that guide adaptive immune system response. His team also established that Th17 produces interleukin-17 and further showed that overexpression of IL-17 causes both autoimmune and inflammatory diseases.  

Th17's involvement in autoimmune disease is probably why it's able to recognize and attack cancer, which is also self tissue. "So a key to developing therapy will be to use Th17 cells that only recognize tumor antigens but do not react to normal tissue," Dong says.

Read the full news release
AAI Honors Chen Dong for Breakthrough T Lymphocyte Research

It's a matter of time. I have no doubt about it. The human will, determination and intellect that invented electricity, the phone, the radio, airplanes, the polio vaccine and penicillin, and that put a man on the moon, will definitely find the cure for cancer. Yet, I agree with most, including those who expressed their frustration in the recent New York Times article, that the war on cancer is taking too long to win. It's a war that we have to win. 

According to the American Cancer Society (ACS), 1,479,350 people in the United States will be diagnosed with cancer this year, and it's expected that 562,340 will die from it. In fact, cancer is the second most common cause of death in the U.S., accounting for 23% of all deaths. This means that one of four people living in the U.S. will eventually die of cancer.

By Tomise Martin, Staff Writer

When Patrick Williams was diagnosed with an aggressive form of brain cancer called glioblastoma multiforme, the three constants he'd always cherished -- family, laughter and colleagues -- helped him cope.

A 27-year veteran of the fire department in Ocean Spring, Miss., he recalls feeling lightheaded and unable to find his balance one day after a staff meeting.

"I couldn't focus, and I needed to brace against a wall for support," Williams recalls. "All I wanted was to go home and take a nap."

Luckily a friend and colleague, trained as a registered nurse, noticed Williams' difficulty and quickly reacted.

"Initially, he and I joked about me slowing everyone down," Williams says. "The banter turned to concern once he heard my symptoms."

As the colleague was taking him to a local hospital, Williams had a seizure. Tests showed he had a brain tumor and would need surgery. It was unknown whether the tumor was cancerous or non-cancerous.

"When anyone mentions cancer, my family thinks of M. D. Anderson," Williams says. "There was no question about my next step."

His first appointment
Days later, surrounded by a group of friends and family, Williams arrived for his first M. D. Anderson appointment.

His surgeon, Sujit Prabhu, M.D., associate professor in the Department of Neurosurgery, told him the tumor was stage IV glioblastoma multiforme, the most common form of brain cancer, and was located in his right parietal lobe. Prabhu explained that the side effects from surgery could include blurry vision, impaired spatial orientation and headaches.

Three days later, Williams emerged from surgery unable to see images to the far left.

"If a board read 'nurse manager,' I would only see 'n rs  m nager,'" Williams says.

Although Prabhu described the possible side effects very clearly, Williams felt unprepared for the outcome. He still considers the experience unreal.  

Multidisciplinary care
With a team of brain cancer experts, including a neurosurgeon, neuro-oncologist and a radiation oncologist, Williams benefited from M. D. Anderson's multidisciplinary approach to cancer care.

After surgery, he met with Monica Loghin, M.D., assistant professor in the Department of Neuro-Oncology. She checked his neurological functions and discussed the remaining treatment options -- chemotherapy, radiation and clinical trials.

"With chemotherapy and radiation still available, I had no desire to try the third option," Williams says.

Loghin prescribed Temodar® (temozolomide), an oral therapy found to be effective for some patients with glioblastoma multiforme, and referred Williams to Anita Mahajan, M.D., associate professor in the Department of Radiation Oncoloy, for radiation therapy.

To complete his radiation treatments, Williams moved to Houston. While the side effects of treatment were hair loss and nausea, his spirits stayed high with frequent family outings and dining at his favorite restaurants.

Try, try again
During a follow-up appointment with Loghin about six weeks later, Williams learned that the brain cancer had not responded to chemotherapy. As a result, he chose to join a Phase II clinical trial studying the effectiveness of XL184, an investigational drug, on glioblastoma multiforme.

In January 2009, he received the good news that some tumors had disappeared or stopped growing.

Life as a brain cancer survivor
Life has changed. Williams has retired as fire chief of the Ocean Springs fire department and his energy level has dropped. But his vision has cleared enough so he's able to drive again on a limited basis.

"I plan activities with their needed recovery time," Williams says. "One day of fishing is followed by two days of rest."

But he doesn't let these new details hamper life. He's usually cracking jokes or surrounded by his friends and family. A brother-in-law always accompanies him to follow-up appointments, which are every four weeks.

"I'm fortunate to have the love and support of my family," Williams says. "Life is what you make of it. I choose to live mine filled with laughter and surrounded by my loved ones."

Related article:
Q&A: Coping With a Brain Cancer Diagnosis and Treatment

M. D. Anderson resource:

Brain and Spine Center

Additional resources:
Brain Tumors (American Cancer Society)

Brain Tumor (NCI)