Written By Dawn DeBolt, BS, RHIA, CTR- Chief Operating Officer for Registry Partners
I had the pleasure of attending the annual Nevada Cancer Control Summit meeting held at Springs Preserve in Las Vegas, Nevada on September 15th, 2016. The meeting was filled with presentations spanning the entire cancer care continuum providing attendees the opportunity to earn 6.5 CE credits with various concurrent sessions throughout the day. The Nevada Cancer Coalition, organizers of the meeting, did a phenomenal job planning the annual Summit.
The most fascinating presentation for me personally was by Dr. Collin Correnti, Scientist, from Fred Hutchinson Cancer Research Center in Seattle, Washington.
The title of Dr. Correnti’s presentation was “Tumor Paint and Optides: Building on 3.5 billion years of Drug Discovery, Project Violet”. The Project Violet program is made up of a team of Fred Hutchinson scientists, who are developing breakthrough treatments through the creation of a new class of drugs, to cure diseases presently considered incurable.
Part of Dr. Correnti’s presentation outlined one of the huge successes at Fred Hutch with something they refer to as Tumor Paint (or BLZ-100). This Tumor Paint, which is also described as a “molecular flashlight”, was discovered by Fred Hutch through research they have completed using scorpion venom. When Tumor Paint is injected into the body, it attaches itself to cancer cells and causes them to “light up”. Tumor Paint is considered thousands of times more sensitive than MRI.
Dr. Correnti explained that Tumor Paint helps surgeons easily differentiate between cancer cells and surrounding healthy tissue, improving tumor operability. This discovery is now being tested in Phase 2 clinical trials. There are five trials presently being offered for Breast, Colon, Prostate, Lung, Brain, Sarcoma and other solid tumors with approximately 60 patients enrolled. They have found to date that Tumor Paint has illuminated over 80% of the tumors in the population being studied. To illustrate how Tumor Paint works, Dr. Correnti shared pre-operative MRI images of a brain tumor and what the same image looked like “after” Tumor Paint was injected. It was amazing to see how well the Tumor Paint lit up the tumor cells but more importantly how much of the tumor would have been left behind (that appeared to be normal tissue on imaging) if Tumor Paint had not been used.
In addition to Tumor Paint, Dr. Correnti and the Fred Hutch team are researching various other “natural elements” from plants and animals hoping to discover other new anti-cancer compounds. He explained that plants and animals make “knottin peptides” for survival. Some knottin peptides have attributes such as: 20-60 amino acids, 3-4 disulfide bridges, protease resistant, low-immunogenicity, antibody-like affinity, cell penetration and blood brain barrier penetration.
He pointed out that scientists had previously discovered about 2,000 knottins, but his team has identified over 200,000 “knottin like” sequences. One of the biggest challenges is that some knottins are difficult to make and natural sources are limited. To address this, Dr. Correnti explained that they have developed a process at Fred Hutch where these knottin peptides can be synthesized, but each peptide is a unique project. The Fred Hutch team refers to the knottin peptides as “optides” because they are essentially “optimizing” the peptide. These optides are engineered to attack cancer cells while sparing normal cells and tissues around them. Optides are proteins with molecular biology and they can be found in spiders, scorpions, plants, bacteria, and various other natural resources.
Dr. Correnti mentioned much of their funding is raised by families of patients who have been diagnosed with an incurable cancer diagnosis and have entered the Fred Hutch health system hoping to find a cure for their loved ones. These families organize bake sales and fun runs to raise money so Fred Hutch can continue their research. Hearing about all of the remarkable work the Fred Hutch scientists are doing to find a cure for cancer and other disease processes was very empowering and encouraging. It is very uplifting to think the cure for cancer and other disease processes could be right before our eyes, in our own backyards and communities … “in nature”.
To learn more about Project Violet, Tumor Paint and all of the other work Fred Hutch scientists are doing, please visit: http://www.fredhutch.org/en/labs/clinical/projects/project-violet.html and follow Fred Hutch on social media. If you are ever looking for a good cause to donate to, I encourage you to consider donating to Project Violet so the scientists at Fred Hutch can continue to make progress with the amazing work they are doing.
The other concurrent sessions at the Nevada Cancer Control Summit that I had the pleasure of listening to were:
- Genetics and Genomics in Cancer Prevention and Treatment – a Keynote address by Dr. R. Nathan Slotnick, MD, PhD, Perinatologist at Perinatal Associates of Northern Nevada and Medical Geneticist at Cancer Genetics Risk Assessment. Slotnick discussed the approach and management of the most common hereditary syndromes (HBOC, FAP, AFAP, MAP, Peutz Jeghers, & HNPCC (aka Lynch Syndrome)) and how to identify the features of each condition, how to know when to initiate a referral and appreciation of the changes in medical management and its purpose in early detection and/or prevention in cancer. He also shared what’s new in next generation sequencing panels, cancer genotyping and genetic directed cancer therapeutics. Dr. Slotnick shared a you tube video to illustrate next generation tumor sequencing https://www.youtube.com/watch?v=womKfikWlxM. He also shared a website called www.mycancergenome.org which provides a tool for matching tumor mutations to therapies, provides up-to-date information on what mutations make cancer grow and available clinical trials by type of cancer.
- Obesity and Cancer presented by Dr. Oscar B. Goodman Jr., MD, PhD., Medical Oncologist and Clinical Researcher at Comprehensive Cancer Centers of Nevada (CCCN). Goodman presented some staggering statistics about obesity, one statistic he discussed was the obesity rate globally which is projected to double by 2030 to 3 billion people. He provided the website http://obesity.procon.org/ as a resource for additional statistics and information surrounding obesity. He shared that obesity accounts for 20% of all cancer related deaths and is linked to various GI cancers (hepatoma, gallbladder, pancreas, esophageal, gatric, colorectal), Endocrine cancers (post-menopausal breast, aggressive prostate cancer, ovarian, endometrial) and Kidney cancer. He pointed out that obesity facilitates tumorigenesis through mechanisms such as: inflammatory cytokine production which results in permissive paracrine signaling, perturbs of normal hormonal signaling pathways and visceral fat which nurtures the development of metastatic disease. He expressed the importance of weight loss as a key treatment for cancer diagnosis in obese patients.
- Melanoma as a Public Health Issue presented by Dr. Wolfram Samlowski, MD, FACP, Clinical Professor at University of Nevada, Reno. Dr. Samlowski reviewed the inherited factors of Melanoma including Caucasian race which makes up about 95% of all melanomas, inherited predisposition which precludes 1 in 10 melanoma patients will have affected family members, weak inherited modifier genes which include MCR-1 mutations (red hair, fair skin, burns easily). He further stated on a population basis, melanoma patients have 2 fold increased odds of an affected relative. He outlined familial melanoma specifically where there is a very strong family history of melanoma where multiple individuals in a family have melanoma. He stated these families can also have an associated risk of pancreatic cancer and inheritance is 50:50 (autosomal dominant) stating genetic testing may be useful for some families. He also explained the Rule of 3 which implies a 25% risk of inheriting melanoma. The Rule of 3 includes 3 melanomas in the family, 3 melanomas in one individual or Melanoma + pancreas cancers in the family = 3. He discussed prevention efforts and outlined Australia’s “Slip. Slap. Slop” initiative … Slip into long sleeves and pants, Slap on a hat, Slop on sunscreen. He stated the majority of skin lesions are benign and melanoma tends to develop gradually so self-examination is key to identifying melanomas early. If you have a significant number of moles enlist a family member to assist you with self-exams, consider taking digital photos (cell phone) to monitor moles to help identify changes and see the dermatologist regularly. He reviewed the common ABCDEs of Melanoma diagnosis: Asymmetry (half of the lesion is shaped differently than the other half), Border (the border is irregular, blurred or ragged), Color (inconsistent pigmentation, with varying shades of brown and black), Diameter (>6mm or a progressive change in size), Evolution (history of change in the lesion). He reviewed the advantages of targeted therapy but this type of therapy only works if there is a specific genetic mutation. Targeted therapy typically results in drastic tumor shrinkage and improved survival, however, over time most cancers become resistant and thus there are rare long term responders. He explained the advantages of immunotherapy and its effectiveness which is not linked to genetic mutations. He mentioned the immune response can take weeks to months to show an effect and there is potential for slowing cancer growth. It has shown improved survival in melanoma with long term remissions (20-50%), there is the potential for cure and it can be combined with other cancer treatments.
- Recommendations for Patient Compliance with Oral Chemotherapy presented by Elizabeth Bettencourt, RN, MSN, OCN, Chemotherapy Nurse Navigator at Palo Alto Medical Foundation (now part of Sutter Health) in California. Bettencourt outlined three barriers that can influence a patient’s ability to adhere to an oral chemotherapy regimen, reviewed three teaching/education interventions that help ensure patients adhere to the treatment regimen, and presented two measures that can aid in reducing the severity of side effects to oral chemotherapy. When you think of oral chemotherapy the first thing that comes to mind since it is taken by mouth vs. infusion is how much easier this would be for the patient and healthcare team. The reality is quite the contrary. One of the barriers to oral chemotherapy is:
- Drug Access. Bettencourt explained the challenges with drug access one of which is cost (ex: 3 doses of Ibrutinib cost $16,400 without insurance), another is length of time to obtain access to the drug and lastly having to use specialty pharmacies to fill the prescriptions.
- Another barrier is Adherence which includes treatment complexity (i.e. dosing complexity, multi-drug complexity, dosing changes); patient education level (some patients believe oral chemotherapy will not be as effective as IV chemotherapy, others believe oral chemo implies their disease is not severe and there are also challenges with language and cultural barriers). Another adherence barrier is Side Effects (patients have less frequent contact with the oncology team when taking oral chemotherapy so there are issues with under and over adherence, issues with patients who believe if they are not experiencing side effects, the drug must not be working so they stop taking it)
- Another barrier is Storage, handling and disposal of oral chemotherapy (education on safe handling of the drug, once taking the drug how this impacts your bodily fluids and exposing others in your family to the toxicity of the drug, and ensuring patients understand how to properly dispose of the drug. IV chemo is disposed of following a special procedure at the healthcare facility, however, patients have to follow a special procedure for disposing of oral chemotherapy as well).
The challenges with oral chemotherapy are very real and it is up to each facility to outline a comprehensive education and follow up plan for each patient to ensure they are properly educated on all aspects of taking oral chemotherapy. There are difficult challenges with this form of chemotherapy and although it appears to be an easier way to administer chemotherapy there are many challenges different from intravenous chemotherapy. Ms. Bettencourt’s facility recognized the importance of having a dedicated nurse navigator for oral chemotherapy patients due to the complexity of the barriers associated with this treatment regimen.
Kudos, to the Nevada Cancer Coalition for coordinating a comprehensive and informative line-up of speakers for this year’s Summit. There were many additional presentations not summarized here that provided educational content of high quality and great value. We would like to congratulate our two raffle winners: Jymmie Charland and Sandra Alarcon-Cortez. Thank you to the Nevada Cancer Coalition for the opportunity to exhibit and network with the conference attendees. We look forward to attending next year’s Summit to be held in Reno, Nevada.