2017 Annual Retreat on Cancer Research Public Forum Highlights

I was pleased to have the opportunity to attend yesterday's Public Forum segment of the 2017 Annual Retreat on Cancer Research in New Jersey presented by the Rutgers Cancer Institute of New Jersey (RCINJ) and the New Jersey Commission on Cancer Research. This years Forum topic was Precision Medicine. The Event took place at the Rutgers College Avenue Student Center.

After an introduction and welcome by Shridar Ganesan, MD, PhD (RCINJ),  Dr. Kim Hershfield spoke on The Promise and Practice of Precision Oncology. After a short review of the structure of the cell and DNA, she described how oncogenes and tumor suppressor genes work. In the past, treatments were based on the organ where the cancer was found and the cancer's histology. Today knowledge of a tumor's gene mutations can lead to the use of a targeted therapy. Knowledge of the mutations that can cause a cancer has increased in the past few years and researchers like those at RCINJ are working to understand the impact of those mutations and develop targeted therapies for them.

Another avenue of recent study is the use of a  liquid biopsy. With a liquid biopsy, a blood sample is examined for circulating DNA from a cancer tumor.

As Dr. Hershfield mentioned Precision Medicine is at the "toddler" stage.  But every day researchers are looking to develop new treatments, test combination therapies, understand and reduce side effects, understand pathways, all with the goal of providing the best treatments for cancer patients.

The second speaker was Hetal Vig, MS a genetics counselor from RCINJ who spoke on Capturing the Spectrum of Hereditary Cancers: A Moving Target in the Setting of Targeted Therapy. Cancer may develop due to mutations that are germline ( hereditary) or sporadic. When examining a patient's family history it is important that both the maternal and paternal sides of the family are examined.

As an example, Ms Vig mentioned how BRCA mutations increase a person's risk for breast, ovarian and pancreatic cancers. Every person has two of each gene. When you have a germline mutation the mutation comes from the egg or sperm. If you are born with a BRCA mutation in one gene and over time you should develop a BRCA mutation in the second gene you can develop cancer. When you have a sporadic cancer  you are born with no mutations in either gene but over time for some reason both your genes develop a BRCA mutation which can lead to cancer. So there are less steps to go through when you start out with a hereditary mutation to develop cancer. And it also explains why most sporadic cancers develop later in life since it takes more time for the mutations to occur.

Ms Vig also talked about incidental findings on genetic testing results. A framework needs to be developed regarding how to share those findings with patients. Interpreting the complex genetic test results many patients receive should be done by a trained genetic counselor.  (I agree 100%.)

The final speaker of the morning, Dr Eric Singer , RCINJ spoke on Ethical Issues in Precision Oncology. Dr Singer's talk began with a discussion of clinical trial design and informed consent. Do patients really know that the trial they are taking part in is for research and may not offer them any benefit? Dr Singer also mentioned incidental findings and how those findings should be shared with patients. Dr Singer mentioned that is is important that health care providers protect patients from misinformation.

He also stressed the need for oncologists to know their patient's goals. Part of the discussion could include the cost the patient will have to bear when taking new expensive targeted therapies.The patient / health care provider discussion could include: Will the treatment extend survival? Will the treatment have toxic side effects? What patient reported outcomes have other patients provided? Is the decision to use the treatment performance-based or value-based?

I was happy to see in each of the presentations the patient being central to the treatment decision. 

After the Forum I took some time to view the posters outside the Multi-purpose room. Here is one of particular interest to those with ovarian cancer.

Impact of Body Mass Index on Ovarian Cancer Survival Varies by Stage
Elisa Banderas et al
This study looked at the impact of obesity on ovarian cancer survival
It included over 1100 women with epithelial ovarian cancer diagnosed between 2000-2013 at Kaiser Permanente Northern California. "There was no evidence of an association between BMI( body mass index) on overall or ovarian cancer-specific survival" but they found a strong association by stage.
Conclusion: "Associations of obesity with ovarian cancer survival differ by stage, with decreased survival among those with localized disease and increased survival among those with late-stage disease. "

I look forward to next year's Retreat.

Dee
Every Day is a Blessing! Thankful for the doctors, researchers and staff throughout the state of NJ who are striving to understand cancer and make their patient's lives better. 

Public Forum - 2017 Annual Retreat on Cancer Research in NJ

The Annual Retreat on Cancer Research in New Jersey is hosted by the Rutgers Cancer Institute of NJ and the New Jersey Commission on Cancer Research. The event includes poster sessions and mini-symposium on research by expert NJ researchers.

The day also includes a Public Forum. I have been lucky to have attended a few of the public sessions over the past few years. Last year's public forum topic was Survivorship. This year, the topic is Precision Medicine.

The topics of discussion will be:
The Promise and Practice of Precision Oncology
Capturing the Spectrum of Hereditary Cancers: A Moving Target in the Setting of Targeted Therapy
Ethical Issues in Precision Oncology.

This years event will take place on May 25, 2017  (8:30-10:00 am) at the Rutgers College Avenue Student Center.

Registration is free.
Please register on the following website: http://www.mpi-evv.com/2017NJCR/2017PFReg.asp

I've already registered for the event. How many of my fellow advocates and survivors will join me?

 See you on the 25th!

Dee
Every Day is a Blessing!

2014 Annual Retreat on Cancer Research In NJ: Public Forum Personalized Cancer Therapy

For the past few years, I have attended Public Forums that are part of the Annual Retreat on Cancer Research in NJ. Today's forum on Personalized Cancer Therapy held a special interest for me.

I have always wondered how my cancer was different from other women who were diagnosed with Stage 3 serous papillary epithelial ovarian cancer (high grade). Why did my tumors respond so well to chemotherapy treatments? Why was I able to go into remission for a second time for a longer period of time than my first remission?  Well, there are researchers in NJ who are asking the same questions. They are looking beyond the organ and histology but looking at the genetics of tumors. 

You may recall that last year I was asked to participate in a clincial trial in which tumor tissue from my initial diagnosis and my recurrence well as my blood would undergo genetic sequencing.  I learned a bit more about that process today at the public forum. 

Dr. Shrindar Ganesan, Rutgers Cancer Institute of NJ ( RCINJ),  and the lead investigator of the trial I participated, in welcomed everyone to the forum. He explained that genome sequencing is generating a large amount of information and what must now be done is to transfer that into useful knowledge for patients. He also said that each patient has a unique response to treatment be it chemotherapy, immunotherapy or targeted therapy. He then went on to introduce each of the other speakers. 

Dr. Kim Hirshfield ( RCINJ ) began "Next-Generation Sequencing for Every Generation:Everything you Need to Know but Didn't Know to Ask"  by telling us that "one size fits all" in cancer treatment does not work due to differences in individuals and tumors. She went on to explain about chromosomes, genes and how proteins are involved in the growth, proliferation , death and movement of cells. She described oncogenes and tumor suppressor genes and how they can cause cancer. There are also different type of mutations: germline mutations which are mutations you are born with and  somatic mutations those which are acquired later in life. 

Dr Hirshfield then went on to describe the Precision Medicine Initiative in which researchers are trying to understand the biology and mutations of tumor cells in order to offer patients the best treatment. Tumor samples are evaluated for 236 genes. The data from the evaluation is presented to a Molecular Tumor Board which helps determine the treatment. So far 100 patients have taken part in the Initiative. Twenty percent have been prescribed treatment based on their evaluation, another 20 percent have treatment plants but have not yet been prescribed the treatment due to the fact that they are stable or are in remission at this time. For the remainder of the patients some are no longer participating in the study for various reasons and for some there are no current drugs or trial drugs available for their specific mutations. In the 100 patient tumor samples tested there was an average of 3.6 mutations. 

Hetal Vig, a genetic counselor at RCINJ, presented "Capturing the Spectrum of Hereditary Cancers:A Moving Target in the Setting of Targeted Therapy.  She spoke about family pedigrees and germline mutations. Women with BRCA1 mutation have a 60% risk of developing ovarian cancer while those with the BRCA2 mutation have a 25% risk of developing ovarian cancer. She then went on to mention Li-Fraumeni Syndrome ( I had not heard about this syndrome before and will have to look into it further.) This syndrome is linked to the p53 mutation. Hetal also said that all cancers are genetic but not all cancer is hereditary.  

Although the last speaker, Dr Janice Mehnert (RCINJ), spoke mainly about melanoma I found her presentation very exciting because of the progress that has made in less than 10 years in Melanoma treatments. In 2006 there was no good treatment for melanoma. Then they found that they could target the BRAF and MEK genes with some success (Vemurafenib). There has also been success with immunotherapy by targeting the PD1 and PDL1 genes. It may be possible to use targeted therapy and immunotherapy together but clinical trials are needed since more targets may translate into the treatment being more toxic to the patient.  Dr Mehnert then said that "Your tumor is your life" and the focus should be on the understanding each patients tumor. 

During the question and answer period I learned that:

The more suppressed the immune system the more cancer.

When using immunotherapy there may be an increase in tumor size due to inflammation but if the therapy is effective subsequent shrinkage will  occur. 

The researchers agreed that more advocates are needed to raise awareness of the importance of participation in clinical trials.  

I am so pleased to see such important research being done right here in NJ. I also urge my readers to consider participation in a clinical trial. It is through clinical trials that the knowledge we need to better understand how to target our individual cancers can be found. 

Dee

Ever Day is a Blessing!

Precision Medicine at CINJ

Recently there has been a stress on personalized medicine in the treatment of cancer. We know that cancer although the same type, such as epithelial ovarian cancer ( the most common ovarian cancer), may vary from patient to patient due to the cancer's unique molecular makeup.  Standard treatment that may work for one woman may not work for another and the cancer will progress. What is needed is an understanding of the molecular and genetic makeup of each individual's cancer to best treat the disease.

The Cancer Institute of New Jersey has begun an initiative called Precision Medicine. This initiative which includes the use of bioinformatics will allow researchers to collect both clinical and genetic information to determine diagnosis, prognosis and best course of treatment in a more targeted manner than in the past. This is good news for cancer patients.

What makes me especially happy is that this initiative will be lead by Lorna Rodriguez, MD, PhD  chief of gynecologic oncology at CINJ since 2000, one of my gyn-oncs and lead investigator of the selenium clinical trial I participated in. It is because of her many investigator-initiated trials into cancer metastasis and drug resistance that makes her the perfect person to lead this research.

To read further about this program please click here.

Dee
Every Day is a Blessing! I am especially blessed to be treated at a center that is at the forefront of cancer research.