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Investigational Pharmacy Services for cancer patients

By Jacqueline Mason

Our doctors are dreamers. They dream of conquering cancer and adding meaningful years to our patients' lives. Our Investigational Pharmacy Services team helps them turn those dreams into reality.

This highly specialized team of eight pharmacists and 11 pharmacy technicians enables MD Anderson to have the largest clinical trials program in the world.

Every investigational drug that enters our institution travels through the Investigational Pharmacy Services area on Floor 1 of the Main Building. We have 1,100 clinical research protocols underway, involving more than 8,000 patients. That translates to 35,000 investigational doses a year, or one dose every 15 minutes.

By centralizing the way we administer investigational drug trials, the team enables breakthroughs in cancer care for doctors and researchers like Hagop Kantarjian, M.D.

Patrick Hwu melanoma immunology expert

By Lori Baker

Many melanoma patients know Patrick Hwu, M.D., as the oncologist and immunology expert who saved their lives. But Hwu, who has headed up our Melanoma and Sarcoma departments, now also leads our largest academic division: Cancer Medicine.

We recently spoke with Dr. Hwu to learn more about what drives and inspires him both here at MD Anderson and at home. Here's what he had to say.

Where were you raised?

I grew up in St. Albans, West Virginia, which had only 13,000 residents at that time. I often think about MD Anderson having more people than my hometown.

What words best describe you?

Passionate, committed and enthusiastic.

Thyroid_Lockey_249.jpgBy Lori Baker

Hugh Lokey travels 497 miles each time he comes to MD Anderson for thyroid cancer treatment. Then it's 497 miles back home to Broken Arrow, Okla. He's been making the trip for five years, sometimes twice a month.

"It's been tremendously worth it," says Hugh, a 70-year-old Marine Corps veteran who's benefited from, and perhaps even survived because of, lenvatinib. This new thyroid cancer drug was tested here and approved by the Food and Drug Administration (FDA) in February.

Like Hugh, the drug had a long journey, and each step was taken at MD Anderson.

New hope after decades with one treatment
Until recently, patients with radioiodine-refractory thyroid cancer had only one treatment option. And it didn't work for more than half.

Their fates took a turn for the better in 2006.
 
"In 2006, we began testing a drug called E7080 and found that several tumor types responded," says David Hong, M.D., in Investigational Cancer Therapeutics. "The response was particularly remarkable in thyroid cancer patients."

Patient64.jpgJames (Jim) Boysen first met Jesse C. Selber, M.D., four years ago. The Austin-based software developer had come to MD Anderson for reconstructive surgery after successful treatment for leiomyosarcoma, a rare cancer of the smooth muscle, on his scalp had left him with a large, deep wound on his head.

But Jim, now age 55, didn't just need reconstructive surgery on his scalp and skull. He also needed another kidney and pancreas transplant. He'd previously received a kidney and pancreas transplant in 1992, due to complications from juvenile diabetes.

This presented a Catch-22 for Selber. The scalp and skull wound kept doctors from performing the second solid-organ transplant. Likewise, Jim's kidney and pancreas functions, along with his immunosuppression medications for his pancreas and kidney, complicated scalp reconstruction.

But Jim's wound, medication and organ failure ultimately became part of the solution. On May 22, he became the first person ever to receive a scalp and skull transplant simultaneously with solid organ transplants.

A transplant four years in the making
"When I first met Jim, I made the connection between him needing a new kidney and pancreas and the ongoing anti-rejection medication to support them, and receiving a full scalp and skull transplant at the same time that would be protected by those same medications," says Selber, who came up with the idea of performing the scalp and skull transplant at the same time as the kidney and pancreas transplant. "This was a unique situation that created the opportunity to perform this complex transplant."

FB_esophagealcancer.jpgEsophageal cancer is most common in middle-aged men who are overweight and have a history of acid reflux or heartburn. But our esophageal cancer team -- one of the few in the United States -- diagnoses this disease in all kinds of patients.

We talked with with Ara Vaporciyan, M.D., and Mara Antonoff, M.D., to find out what you need to know about esophageal cancer symptoms, risk factors and treatment. Here's what they had to say. 

Who's at risk for esophageal cancer?

Known risk factors for esophageal cancer include old age, male gender, obesity, longstanding heartburn, tobacco use, alcohol, and diets heavy in processed meats. Having reflux or Barrett's esophagus, a complication of reflux, poses the greatest risk.

People with exposure to certain chemicals, history of injury to the esophagus, human papillomavirus (HPV) or a history of cancer also are at increased risk.

Remember, having these risk factors doesn't mean that you'll get esophageal cancer. And some people who develop esophageal cancer don't have any risk factors.

430_ueno.jpgWhen doctors diagnose breast cancer, they look for three types of receptors -- estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2) -- expressed in the breast cancer. These are what cause most breast cancers to grow. They're also what our doctors typically target when treating breast cancer.

But some breast cancer patients lack these receptors. When this happens, the breast cancer is called triple-negative. And, without any receptors, it can be more challenging to treat. This is why triple-negative breast cancer (TNBC) is one of the cancers we're focusing on as part of our Moon Shots Program to dramatically reduce cancer deaths.

We recently spoke with Naoto T. Ueno, M.D., Ph.D., section chief of Translational Breast Cancer Research in Breast Medical Oncology, to better understand TNBC. Here's what he had to say.

Are some people more likely to develop TNBC?
TNBC affects women and men of all races and ages. Compared to other types of breast cancer, we tend to see this disease more in premenopausal women than older women. We're still trying to understand why these groups are more likely to develop TNBC.

Triple-negative patients are more likely to have a BRCA1 or BRCA2 gene mutation compared to non-TNBC patients. But you can still develop TNBC even if you don't have the BRCA1 or BRCA2 mutation. We're still trying to understand the link between TNBC and BRCA.

136197_Jonasch_E.jpgIn the 1980s, the American Cancer Society reported that 80% of kidney cancers were diagnosed in the late stages. Today, thanks to better screening methods, only about 40% of cases are discovered at the advanced stage even though patients may not have any kidney cancer symptoms

At MD Anderson, we're continuing to make progress in improving kidney cancer diagnoses and kidney cancer treatment. We spoke with Eric Jonasch, M.D., associate professor in Genitourinary Medical Oncology, to find out more about kidney cancer treatment and research, as well as prevention and diagnosis. Here's what he had to say.  

Who's at risk for kidney cancer? What signs and symptoms should people look for?
Those who have a first-degree relative, like a parent or sibling, who have had kidney cancer are more likely to develop kidney cancer. So are men, as this type of cancer is seen in men twice as often as in women.

In addition, the older we get, the greater our risk becomes. Most kidney cancer patients are over age 60. People who are obese, have high blood pressure or smoke also are more likely to be diagnosed with kidney cancer.

How is kidney cancer diagnosed?
Increasingly, kidney cancer is diagnosed incidentally, when a patient comes in for an unrelated complaint that requires a CT scan and the care team discovers a mass in the kidney.

Kidney cancer symptoms don't often show themselves, but patients whose cancer has progressed to a later stage may experience pain in the stomach or lower back, or blood in their urine.

Patients with kidney cancer also may experience unexplained high hemoglobin levels, unexplained uncontrollable blood pressure or unexplained and persistent weight loss.

Once the cancer is spotted through the CT scan, and there is no sign of spread to other organs, the surgical team may proceed directly to a surgical removal of the tumor. But if the tumor looks abnormal or like it has grown outside of the kidney, they may perform a biopsy to determine if it is a different cancer type.

pathology_group_163_Edited.jpgBy Carol Bryce

It's not unusual for a patient to arrive at MD Anderson with one diagnosis and leave with a different one.

For example, when approximately 2,700 patient cases were reviewed during September 2011, 25% showed discrepancies between the original pathologists' reports and our pathologists' reports. While the changes in diagnosis were minor in 18.7%, in the other 6.2%, the diagnosis change made a major difference.

"In some of those cases, we changed the diagnosis from malignant to benign or vice versa," explains Lavinia Middleton, M.D., professor in Pathology. "That adds up to approximately 2,000 cases per year where we can say that our pathologists' reviews have impacted patients' treatment.

"Changing the diagnosis from malignant to benign is the best call to make. This makes us feel really good."

"Review of outside material is a major component of the work done by our Pathology and Hematopathology departments," adds Stanley Hamilton, M.D., division head in Pathology/Laboratory Medicine. "The correct pathologic diagnosis and stage of each tumor are key to high quality care for patients."

How we make the correct diagnosis
So why do we find things overlooked by other health care institutions?

"Our system here helps us make the right cancer diagnosis. It's based on three things: sub-specialization, volume and redundancy," Middleton explains.

17shah.jpgEach year, about 24,000 people in the United States are diagnosed with multiple myeloma, according to the American Cancer Society. Most are over age 65, but people of all ages are diagnosed with this blood cancer.

Multiple myeloma is marked by the growth of malignant plasma cells found in the bone marrow. These myeloma cells typically make a protein found in blood and urine.

Over the past decade, we've made tremendous strides in treating multiple myeloma, enabling patients to live significantly longer.  

Jatin Shah, M.D., associate professor in Lymphoma/Myeloma, recently spoke with us about how multiple myeloma is diagnosed and treated, as well as new therapies on the horizon.
Here's what he had to say.

How is multiple myeloma diagnosed?
The most common way to diagnose myeloma in its earliest stages before symptoms appear is through routine blood work. If a patient has elevated protein levels, several tests are conducted and their combined results interpreted in order to make a myeloma diagnosis.
What are common myeloma symptoms?

Before they receive a definitive diagnosis, myeloma patients often have problems with anemia, high calcium or renal failure. Or, they may have broken bones or lytic lesions, where sections of bone are basically destroyed.

Peterson_Trackers_140.jpgBy Carol Bryce

Imagine if you could monitor your health between clinic visits and quickly share the details with your care team.

That's the premise of research that's being conducted here.

"We're looking at new ways of data collection that are grounded in real-world challenges," explains Susan Peterson, Ph.D., in Behavioral Science.

This may help address health issues and behaviors that change when you you're not at the hospital or your doctor's office. For example, patients with head and neck cancer usually don't develop swallowing difficulties while they're at their doctors' offices. And former smokers may not struggle with relapse while they're sitting in clinic waiting rooms.

So our researchers are looking at ways to use modern technology to monitor patients' vital signs, side effects, symptoms and treatment adherence between medical appointments.

Research that's based in reality
In their first study, the researchers tested the use of mobile sensors like fitness trackers and other portable devices that enable patients to monitor their health at home. The study was conducted by researchers from MD Anderson, the University of Alabama at Birmingham and the University of California, San Diego.

Researchers created a system that used mobile applications to gather daily data from patients and send the information to their health care teams. The system, called CYCORE (CYberinfrastructure for COmparative effectiveness REsearch), enables patients to directly enter their personal health information into various devices.

"Using CYCORE, we've been able to gather behavioral, environmental and psychological data that's typically not collected in research trials," Peterson says.

A monstrous art project. A groundbreaking lung cancer screening trial. Inspiring stories from our patients and caregivers. Our mission to end cancer. These are just a few of the topics that been popular on MD Anderson's YouTube channel in 2014.

To find out what you missed -- or rediscover some favorites -- check out our top five videos from 2014.

What drives MD Anderson to end cancer

What if we could end cancer? This is the bold idea that guides everything we do here at MD Anderson. Watch our patients, survivors, volunteers and employees describe the hope they feel here and share why they believe MD Anderson is the best place to treat and ultimately end cancer:



experts.jpgNo matter where you are in your cancer journey, you're likely curious about cancer prevention and treatment. Or, maybe you're trying to figure out how to manage an unexpected side effect or whether or not you can exercise during cancer treatment.

Whatever the case, you're sure to find wisdom, guidance and hope in the insight of our doctors and other experts, many of whom shared their expertise here on Cancerwise and in our Cancer Newsline podcast series in 2014.

Below, we've pulled together some of the most helpful insight and advice our doctors and other experts shared this past year. We hope you find something here that helps or inspires you in your cancer journey.

Immunotherapy: Unleashing the immune system to attack cancer
We're making great strides in immunotherapy, a new way of treating cancer that targets the immune system rather than the tumor itself. And, this innovative approach, developed by Jim Allison, Ph.D., professor in Immunology, will open doors for treating all types of cancer. Learn more in this podcast with Allison and Padmanee Sharma, M.D., Ph.D., associate professor in Genitourinary Medical Oncology and Immunology.

Understanding the new HPV vaccine
Recently, the U.S. Food and Drug Administration approved a new vaccine targeting nine types of HPV, including five that haven't been covered by other vaccines. And, for those who get the vaccine, that means even better protection against cervical cancer, oral cancers and other cancers linked to HPV, says Lois Ramondetta, M.D., in Gynecologic Oncology and Reproductive Medicine. Find out what you should know about the new HPV vaccine.

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