Tag Archive for: cancer

January 2024 Notable News

This month doctors and scientists are applying knowledge learned from cancer patients and research to improve cancer treatment. Doctors must juggle many things when a patient with a chronic illness is diagnosed with cancer. Scientists are learning how forever chemicals encourage the spread of cancer. A new peptide has been designed to inhibit a protein that can stop the growth of 75% of cancerous tumors.

How Do Chronic Diseases Affect Cancer Treatment?

A cancer diagnosis is challenging enough. But having a chronic disease, such as diabetes, high blood pressure, heart disease, or kidney problems, can affect how doctors treat your cancer reports Everyday Health. Cancer diagnosis can happen to older adults who already have many coexisting conditions that require medications. Drug interactions can occur with cancer medicines and chronic condition medications, causing side effects. Some chronic health problems like diabetes increase the risk of infection, making it harder to recover from some cancer surgeries. Some surgeries to remove cancers can make chronic health problems worse, like lung cancer removal affecting chronic lung disease patients. Chronic health problems can eliminate some cancer patients from qualifying for clinical trials. Physicians have a scoring system tool to use that helps choose appropriate treatments for cancer patients. It is the ECOG, Eastern Cooperative Oncology Group scoring system. Doctors can reduce chemotherapy medications doses to avoid complications that can arise from combining chemotherapy with medications for chronic illness. Some cancer patients must prioritize other health issues and treat the cancer when it is safe to do so. It is a careful balance that involves good communication between the patient and the doctor. Click here for the full story.

“Forever Chemicals” Encourage Cancer to Spread Around the Body

In a new study by researchers at the Yale school of public health, two “forever chemicals” spurred cancer cells in the lab to migrate to new positions, an indication that the chemicals could contribute to cancer metastasis in living organisms reports earth.com. These industrial chemicals don’t break down and have toxic effects on the body. The chemicals (PFAS) are found in drinking water, indoor dust, cleaning products, and even interior coatings. Levels of PFAS are showing up in the blood of newborn babies, in sea life, and in bird eggs. Firefighters are having an increased rate of cancer from exposure to PFAS through their jobs. Scientists study the effects of PFAS chemicals using experiments with metabolomics, a tool that studies small molecules. These chemicals are found to cause effects at a cellular level that show metastatic potential. Click here for the full story.

Scientists Succeed in Stopping Cancer Engine Fueling 75% of Tumors

Scientists have developed a peptide that holds promise in controlling the activity of the MYC protein, a key contributor to exacerbating 75% of human cancer cases reports Interesting Engineering. This peptide inhibits the function of a protein MYC; in cancer the MYC’s activity is not regulated properly. MYC helps promote cancer growth when not regulated. When it is regulated, MYC transcribes RNA and DNA. It has a globular shape, making it difficult for drugs to bind to it. This new research has found a peptide that can bind to MYC. Scientists are using nanoparticles to deliver the peptide into cells, connecting to the MYC protein once inside the cells. This knowledge opens possibilities to design new cancer treatments by limiting the proteins activity in cancer cells. Click here for the full story. 

Cancer Awareness Calendar 2024

January

Cervical Cancer Awareness Month

Blood Donor Month


February

National Cancer Prevention Month

Gallbladder and Bile Duct Cancer Awareness Month

World Cancer Day (February 4, 2024)

National Donor Day (February 14, 2024)

Rare Disease Day (February 29, 2024)


March

Colorectal Cancer Awareness Month

Kidney Cancer Awareness Month

Multiple Myeloma Awareness Month

Triple-Negative Breast Cancer Day (March 3, 2024)

International Women’s Day (March 8, 2024)

Anal Cancer Awareness Day (March 21, 2024)


April

Head and Neck Cancer Awareness Month

National Cancer Control Month

Esophageal Cancer Awareness Month

Minority Cancer Awareness Month

Minority Health Month

Testicular Cancer Awareness Month

World Health Day (April 7, 2024)

AML Awareness Day (April 21, 2024)


May

Bladder Cancer Awareness Month

Brain Tumor Awareness Month

Cancer Research Month

Clinical Trial Awareness Week

Melanoma and Skin Cancer Awareness Month

Skin Cancer Detection and Prevention Month

Melanoma Monday (May 6, 2024)

Women’s Check-up Day (May 13, 2024)

Women’s Health Week (May 12-18, 2024)


June

Cancer Survivors Month

Cancer Survivors Day (June 2, 2024)

Men’s Health Week (June 10-16, 2024)


July

UV Safety Awareness Month

Sarcoma and Bone Cancer Awareness Month


 August

Summer Sun Safety Month

World Lung Cancer Day (August 1, 2024)


September

Childhood Cancer Awareness Month

Uterine Cancer Awareness Month

Gynecologic Cancer Awareness Month

Blood Cancer Awareness Month

Thyroid Cancer Awareness Month

Ovarian Cancer Awareness Month

Prostate Cancer Awareness Month

MPN Awareness Day (September 14, 2024)

World Lymphoma Day (September 15, 2024)

Take a Loved One to the Doctor Day (September 17, 2024)


October

Breast Cancer Awareness Month

Liver Cancer Awareness Month

National Mammography Day (October 18, 2024)


November

Lung Cancer Awareness Month

National Family Caregiver Month

Carcinoid Cancer Awareness Month

Pancreatic Cancer Awareness Month

Stomach Cancer Awareness Month

December 2023 Notable News

This month brings scientists closer to advancing cancer treatments with many new discoveries. A new epitope in tumors has been found and it can be a target for treatments to kill cancer. Cellfree DNA in the blood has been discovered as a new way to monitor cancer in patients. An old drug, lidocaine, has been found to be effective to assist other therapies in fighting cancer. 

‘Time Bomb’ Cancer Treatment Could Blow the ‘Doors’ off Tumor Cells in a Major Scientific Breakthrough

The new method triggers a time bomb in tumors that could open them up to new treatment, US researchers found. It targets cells that line a receptor on the cells’ blood vessel called Fas – or- CD95 that causes the death of that cell when triggered by the right antibody reports The US Sun. Immunotherapy is a valuable cancer treatment, but it helps a small number of patients because the T cells cannot break through most solid tumors. Scientists have now found an epitope, called Fas or CD95 that is part of the tumor cell, and the T cell can recognize it. Scientists can develop antibodies to activate CD95 to assist with CAR T-cell therapy. This new approach can make this immunotherapy effective for more patients, including those with solid tumors. Click here for the full story. 

How We Could Test for Cancer, Even Without a Tumor Sample

There are many different combinations or patterns of mutation that cause cancer, but the most important lesson is cancer occurs because of mutations in the DNA of a cell reports Newsbreak. Two very important kinds of genes are tumor suppressing genes and oncogenes, if they mutate it can allow cancer to grow. Cells put DNA into the bloodstream when they die and from cancer cells growing. Scientists have made machines sensitive enough to detect this amount of DNA in the blood. This technology is still in clinical trials to determine the limit of cell free DNA and the progression of the cancer to get detected. This technology will be helpful to monitor the effectiveness of cancer patients’ treatment over time, and it will be helpful for patients with a high risk of developing cancer. Click here for the full story. 

Lidocaine Makes Cancer Cells Self-Destruct, Study Finds

Doctors may be able to improve outcomes for patients with head and throat cancers simply by injecting the common local anesthetic lidocaine near the site of their tumors, according to a new University of Pennsylvania study reports Freethink . Lidocaine has been found to activate T2R14, a bitter taste receptor. T2R14 is found in many cancer cells causing cancer death for head and neck cancers. This activates two mechanisms, mitochondrial calcium ion overload and proteasome inhibition, causing the cancer cells to die. This new information is valuable to the development of new cancer treatments. The lidocaine would not be used alone, it would be given in combination with other cancer therapies. Click here for the full story. 

Elevating Cancer Advocacy: 10 Strategies for Effective Information Dissemination

As patient advocates we not only want to educate and support cancer research and awareness, but we also want to inspire hope.  In this month’s article, I discuss 10 types of content that can help you communicate and disseminate information, advance cancer advocacy, and encourage and empower those affected by cancer.

1. Treatment Journey Timelines

Share informative timelines outlining the typical journey of a cancer patient from diagnosis to treatment and recovery.

What to share:

  • Key information about surgery, chemotherapy, radiation therapy, immunotherapy, and any other pertinent treatments.
  • Highlight the importance of support systems during treatment.
  • Address the common side effects associated with different treatments.
  • Include images that highlight the various stages of the journey, from diagnosis and treatment to recovery, providing a visual timeline of the cancer experience.
  • Conclude the timeline by exploring the phase of life after active treatment.

2. Visual Content

Use graphics, videos, or infographics to make your content more visually appealing  The human brain processes visual information much faster than text, making visual content not only more engaging but also more memorable. In addition to enhancing understanding and engagement, visual content is more likely to be shared across various social media platforms. People are more likely to share visually appealing and informative content with their networks, contributing to the dissemination of important medical information.

What to share:

  • Make complex concepts more accessible and easier to understand with infographics.
  • Live video streaming can be used to host interactive Q&A sessions and webinars with experts in the field who can answer questions and provide valuable insights. This real-time interaction provides valuable information as well as a more engaging experience for your audience.

3. Personal Stories

Use written narratives, images, and video testimonials to  describe the emotional and physical effects of being diagnosed with cancer.

What to share:

  • Explore the emotional roller coaster you experienced, detailing the shock, anxiety, and uncertainty that often accompany a diagnosis of cancer.
  • Share images that capture the visual aspects of the cancer journey.
  • Offer practical advice on managing the physical side effects of cancer treatment, such as nausea.
  • Share a range of coping strategies such as mindfulness techniques, support group recommendations, and mental health resources.
  • Highlight the importance of seeking professional counseling and the value of connecting with others who have faced similar challenges.
  • Acknowledge the ongoing challenges survivors may face, such as mental health concerns, or a fear of recurrence.
  • Offer words of encouragement and messages of hope. Remind others that they are not alone in their journey and that strength can be found in community and shared experiences.

4. Cancer Prevention Tips

As a cancer advocate, your aim is not only to raise awareness but also to empower others with practical advice that promotes a proactive approach to wellness and reduces the risk of cancer.

What to share:

  • Address common misconceptions surrounding diet and cancer, discussing evidence-based findings on the impact of various foods on cancer risk.
  • Provide practical tips on incorporating a balanced and cancer-preventive diet, emphasizing the importance of fruits, vegetables, whole grains, and lean proteins.
  • Provide actionable advice on incorporating regular exercise into daily routines, catering to various fitness levels and preferences.
  • Outline recommended screening guidelines for various types of cancer, stressing the importance of regular check-ups and screenings based on age, gender, and family history.
  • Collaborate with oncologists, researchers, and other cancer experts to discuss recent research findings related to cancer prevention. Address emerging trends, breakthroughs, and advancements in the field, providing your audience with up-to-date and credible information.

5. Clinical Trial Information

Clinical trials often explore novel treatments that may be more effective than standard therapies. By sharing information about ongoing trials, you can open doors for patients to access innovative and potentially transformative medical interventions.

What to share:

  • Start by providing educational content that explains the concept of clinical trials, their purpose, and their significance in advancing medical research. Break down the different phases of clinical trials, emphasizing how they contribute to the development of new treatments.
  • Acknowledge common concerns and misconceptions surrounding clinical trials, such as fear of receiving a placebo, uncertainty about side effects, or worries about being treated as a “guinea pig.” Provide clear, factual information to address these concerns and build trust in the clinical trial process.
  • Ensure that information is easily accessible to patients. Create user-friendly resources that list ongoing trials, their eligibility criteria, and contact information for trial coordinators.
  • Stress the importance of informed decision-making when considering participation in a clinical trial. Provide resources that guide patients on questions to ask, considerations to weigh, and how to engage in meaningful conversations with their healthcare team.
  • Emphasize the importance of diverse participation in clinical trials. Advocate for increased representation of various demographics to ensure that trial results are applicable to a broader population.
  • Establish partnerships with oncologists, nurses, research institutions, universities, and medical centers conducting clinical trials. Collaborate to amplify the reach of trial information and ensure that advocates are well-informed about the latest developments.

6.  Legislation and Policy Updates

By sharing  legislative changes related to cancer research funding, healthcare policies, and patient rights,  you can empower individuals facing a cancer diagnosis, ensuring that they are aware of their rights and can actively participate in their treatment decisions.

What to share:

  • Advocate for legislation that safeguards patient privacy. Stress the significance of maintaining the confidentiality of medical information and protecting patient data in the digital age. Help your audience understand their rights regarding the privacy of their health information.
  • Advocate for legislation that supports and emphasizes the active participation of patients in their treatment decisions. Share information on laws that empower patients to be partners in their healthcare journey, fostering a collaborative relationship with their healthcare providers.
  • Advocate for initiatives that promote transparent communication between healthcare providers and patients. Stress the importance of clear and understandable information, ensuring that patients have the knowledge needed to make informed choices about their care.

7. Conference Reports

Conference reporting facilitates the dissemination of the latest research, treatment updates, and policy discussions to a broader audience, which is a crucial aspect of cancer advocacy.

What to share:

  • Summaries of key sessions and presentations. Highlight significant findings, breakthroughs, and advancements in cancer research, treatment, and patient care.
  • Livetweet important points, quotes, and visuals to engage a wider audience.
  • Conduct interviews with keynote speakers, researchers, healthcare professionals, and fellow advocates. Gather their perspectives on emerging trends, challenges, and opportunities in the field of cancer.
  • Ensure that your conference reports are accessible to a diverse audience. Use clear language, provide explanations for technical terms, and consider different formats to accommodate various learning styles and preferences.

8. Cancer Awareness Days, Weeks, and Months

Compile a list of key cancer-related awareness days, weeks, or months throughout the year. These designated days are important for educating the public, destigmatizing the disease, and advocating for essential research funding.   Integrate these awareness days into your content calendar, dedicating specific time frames for planning, creating, and promoting content around each designated date.

What to share

  • Highlight significant dates such as World Cancer Day on February 4th, National Cancer Prevention Month, Breast Cancer Awareness Month, etc.
  • Plan focused campaigns during these dates, leveraging relevant hashtags and encouraging your audience to participate.
  • Develop a variety of content types, including articles, infographics, videos, and social media posts, to cater to different audience preferences. Ensure that your content is informative, emotionally resonant, and shareable.
  • Use relevant hashtags associated with each awareness day.
  • Provide educational resources including fact sheets, downloadable guides, and links to reputable sources. Empower your audience with accurate information to promote understanding and dispel myths.

9. Think Beyond Cancer

Thinking beyond cancer-specific days and aligning your advocacy efforts with impactful occasions like International Women’s Day can broaden the scope of your message and connect with a wider audience.

What to share:

  • International Women’s Day (March 8th): Highlight the impact of cancer on women’s health, emphasizing gender-specific cancers and advocating for gender equality in cancer research, treatment, and support.
  • International Day of Yoga (June 21st): Share information on how activities like yoga can complement cancer treatment, alleviate stress, and improve overall well-being.
  • World Mental Health Day (October 10th): Address the impact of cancer on mental health. Provide resources on coping strategies, discuss emotional aspects of cancer journeys, and advocate for increased mental health support.
  • World No Alcohol Day (October 2nd): Share information on the link between alcohol consumption and certain cancers, encouraging responsible drinking habits to reduce cancer risk.
  • World Osteoporosis Day (October 20th): Address the impact of certain cancer treatments on bone health. Provide information on how cancer survivors can maintain bone health and prevent osteoporosis.

9.  Interactive Content

By incorporating interactive content, such as online polls, information can be shared in a more dynamic and engaging way. Audiences are not only educated but also engaged and mobilized through a two-way interaction.

What to share:

  • Turn cancer awareness into an interactive learning experience by crafting polls that function as educational quizzes. Ask participants about cancer-related risk factors, symptoms, or prevention methods, providing instant feedback and valuable insights.
  • Combat misinformation and address stigma by using polls to confront prevalent myths about cancer. Create questions that challenge misconceptions, enabling participants to contribute to dispelling stereotypes and fostering a more informed and empathic online community.
  • Extend the impact of interactive content by promoting cross-platform engagement. Encourage followers to share poll results on various social media channels, multiplying the reach of awareness initiatives and fostering organic conversations about cancer-related topics.

I hope you’ve found these content suggestions helpful. Implementing these ideas can not only raise awareness about cancer but also inspire action, foster community, and contribute significantly to the advancement of cancer advocacy.

You might also like to read

The Patient Advocate’s Guide to Social Media Content Planning – Patient Empowerment Network (powerfulpatients.org)

Transforming Your Social Media Presence: 5 Steps to Foster Inclusivity and Advocate for All – Patient Empowerment Network (powerfulpatients.org)

Patient Empowerment Network joins CancerX Initiative

FOR IMMEDIATE RELEASE 

November 1, 2023

Patient Empowerment Network joins CancerX Initiative 

BOTHELL, WA. – Patient Empowerment Network (PEN) announced today that they have joined the CancerX Initiative, a public-private partnership announced by The White House as a national accelerator to boost innovation in the fight against cancer as part of the Cancer Moonshot campaign. CancerX’s goal is to reduce cancer deaths by 50 percent by 2047.   

“Key to achieving the goals of the Cancer Moonshot is having each and every cancer patient able to access the information they need to engage in shared decision-making,” said Tracy Rode, Executive Director, Patient Empowerment Network. “We believe Patient Empowerment Network (PEN) is an important addition to CancerX because of our focus on health equity and online literacy. We are proud to offer our expertise and energy to CancerX.” 

CancerX is convened and administered by Moffitt Cancer Center and the Digital Medicine Society (DiMe), alongside the Office for the National Coordinator for Health Information Technology and Office of the Assistant Secretary for Health.  

“Multi-stakeholder collaboration is critical to harness the potential of digital innovation in the fight against cancer, and we’re honored to partner with PEN to achieve the ambitious goals of CancerX,” said Smit Patel, Associate Program Director at Digital Medicine Society (DiMe). “Through this impressive collaboration, we will establish best practices, build capacity, and demonstrate the impact of innovation on the life of every person on a cancer journey.” 

PEN’s mission is to offer trusted information to empower anyone impacted by cancer, toward fulfilling our vision of every cancer patient having the knowledge they need to navigate the complexities of cancer.  

# # #  

About Patient Empowerment Network 

Patient Empowerment Network (PEN) is a virtually-based 501(c)(3) non-profit organization trusted by millions of cancer patients and care partners worldwide to achieve improved health literacy, equity, and treatment outcomes at every step of their journey. www.powerfulpatients.org. 

  


Media Contact:    

Emily Reed 

Early Light Public Relations 

Emily@earlylightpr.com 

PODCAST: CAR T-Cell Therapy Care Partners | Understanding Your Role in Patient Care and Recovery

 

Understanding CAR T-cell therapy and recovery is vital for care partners who are caring for a loved one undergoing this treatment approach. Dr. Shambavi Richard explains the CAR T-cell therapy process, potential complications, ongoing research in the field, and discusses how care partners can provide support at each stage of the process.

Dr. Shambavi Richard is the Co-Lead Physician for the Multiple Myeloma CAR-T Program at Mount Sinai Tisch Cancer Center. Learn more about Dr. Shambavi Richard.

Download Resource Guide

See More from The Care Partner Toolkit: CAR T-Cell Therapy


Transcript:

Katherine:

Today we’re going to learn about CAR T-cell therapy to help care partners understand how it works, what happens during recovery, and why care partners are so essential throughout the process. Before we meet our guest, let’s review a few important details. The reminder email you received about this program contains a link to a program resource guide. If you haven’t already, click that link to access information to follow along during the webinar. At the end of this program, you’ll receive a link to a program survey. This will allow you to provide feedback about your experience today. And it will help us plan future webinars. Finally, before we get into the discussion, please remember that this program is not a substitute for seeking medical advice. Please refer to your healthcare team about what might be best for you. Well, let’s meet our guest today.  

Joining us is Dr. Shambavi Richard. Dr. Richard, welcome. Will you please introduce yourself? 

Dr. Richard:

Hi. I’m Shambavi Richard. I am in the myeloma faculty at Mount Sinai. I’m Associate Professor of Medicine. And I codirect the CAR T and cellular therapies for myeloma at my institution.    

Katherine:

Well, thank you so much for joining us today. We really appreciate you taking the time.  

Dr. Richard:

Thanks for having me.  

Katherine:

Let’s begin with the basics of CAR T-cell therapy. What is it? And maybe, actually, we could start with what CAR is short for.  

Dr. Richard:

So, CAR stands for chimeric antigen receptors, so CAR T cell is a chimeric antigen receptor T-cell therapy. What that means is T cells, which is one of the cells for immune system are actually come from the patient. They’re expanded and activated in a manufacturing facility. And there they undergo genetic modification to form the CAR T cells. And what’s special about the CAR T cells is that they have the capacity to recognize myeloma cells and are efficient killers of the myeloma cells.   

Katherine:

Who might this approach be right for? What determines eligibility? 

Dr. Richard:

So, interestingly enough, today as we speak, CAR T cells may be eligible for many, many different kinds of – in the phases, many different phases of the myeloma journey. When they were initially tested, as most new therapies are, they were tested on patients who had very advanced myeloma, really were not candidates or did not have great options for any other kinds of therapy. And when they got tested in these groups of patients, they really had stellar results that far outstripped anything else that we had as options for patients in those advanced stages of myeloma. So, the approval for CAR T cells as they stand today for myeloma is for advance myeloma with patients who have had four or more lines of therapy and have had exposure to pretty much the major three classes of therapies for myeloma which includes proteasome inhibitors, imides, and anti-CD38 antibody therapy.  

But having said that, now CAR T cells are being moved into earlier lines of therapy are now being tested in these in various clinical trials. And even for newly diagnosed myeloma patients to see if they are as good as autologous transplants. Are they better than autologous transplants? And so on and so forth. So, really that’s what I mean by saying for now CAR T cells are appropriate for anyone if they are candidates for clinical trials. But in terms of approved indications for CAR T therapy, those are for advanced myeloma patients who have had at least four lines of therapy.  

Katherine:

Dr. Richard, what are the potential side effects or complications of CAR T-cell therapy? 

Dr. Richard:

So, there are several possible side effects with CAR T therapy.  

It’s a little different from an autologous transplants. And I bring that up just to say because they are both cellular therapies, so are frequently compared and contrasted with autologous transplants which we have had for about three decades now. So, the main side effect after CAR T therapy is something called CRS or cytokine release syndrome. So, that happens when CAR T cells recognize the myeloma cells and kill them. A host of chemicals called cytokines are released in the body. And this can make a person feel like they have a bad case of the flu. So, it may be things like fevers, chills, body pains, headaches, loss of appetite, nausea, fatigue. So, these are some common symptoms of cytokine release syndrome. But these are the milder forms, so in more severe cases of cytokine release syndrome, you can have things like drop in blood pressure, drop in oxygen levels, needing supplementation with oxygen.  

Or in terms of drop in pressure, they may need fluid resuscitation or sometimes even pressors, blood pressure medications that help to boost the blood pressure. So, that’s one major side effect. Another is something called neurotoxicity.  

So, you can have neurological side effects from CAR T therapy which when it occurs in the setting of CRS, that’s called ICANS or immune effector cell-associated neurotoxicity syndrome. That’s what that acronym stands for. And it has a constellation of symptoms such as confusion, disorientation, difficulty with some common everyday tasks. The handwriting may go off, attention deficit, things like that. But then in more severe forms of ICANS, you can actually have lethargy, coma, seizures, brain edema, so much more scary things.  

Then there is another form of toxicity called delayed neurotoxicity which looks completely different. Now you have things like Parkinson’s disease or neuropathies. Either cranial nerve neuropathies or peripheral neuropathies, Guillain-Barre which is a kind of ascending paralysis. So, all of these are also possible as neurotoxic side effects from CAR T therapy. Aside from these, there is another which is called HLH or macrophage activation syndrome or hemophagocytic lymphohistiocytosis syndrome wherein patients can have organ toxicity, a spiking ferritin levels, new fevers, new neurotoxic symptoms, additional lab abnormalities such as liver function test abnormalities. So, these are other forms of just general CAR T-cell toxicity.  

Then in addition to these, you can have infections, prolonged blood count abnormalities, cytopenia as we call it which can affect the white cells or the platelets or anemia and things like that. So, these are also possible. And then finally things like second primary malignancies which can happen, other malignancies that can happen that may be related to CAR T therapy. A lot of these are still being studied. We don’t have a good understanding of how frequently this happens. But these are all possible side effects of CAR T therapy.  

Katherine:

Do any of the complications have to result in hospitalization? Or can patients be treated outside the hospital? 

Dr. Richard:

So, the way things stand now, and this may be slightly different depending on the specific CAR T product.  

But we generally keep patients hospitalized for the first two weeks after the cell infusion. Most of the side effects such as the CRS and the ICANS tends to occur during this hospitalization phase. HLH and delayed neurotoxicities can occur while they’re still in the later phases of the hospitalization, or it can occur late after they get discharged from the hospital. Infections and cytopenias of course can happen for a while following CAR T therapy. Once they are discharged from the hospital, we ask that they stay close to us, usually within an hour or two of the hospital so that they can quickly come back in if there’s any issues. We see them quite frequently once they get discharged from the hospital. I see them at a minimum of once a week, more frequently at least a couple times a week, or even three times a week depending on what their blood count needs and monitoring needs are.   

So, we have them stay close to the hospital if they are far away. And the sponsor and our social worker, insurance can work together to figure out how to help them with the hotel costs if they have to stay close to us. So, that’s for an additional two weeks after they’ve discharged from the hospital. Following that, patients go back to their homes, but we still follow them quite frequently depending on what their needs are in terms of possible side effects.   

Katherine:

Dr. Richard, how is CAR T-cell therapy impacting the landscape of myeloma care?  

Dr. Richard:

So, as I’d hinted or alluded to previously, prior to CAR T cells appearing on the horizon, we had very limited options for patients who had had the first several lines of therapy.  

So, once they had been exposed to two proteasome inhibitors, two iMiDs, and then anti-CD38 antibody which is the three major class of myeloma drugs, they are then called triple class exposed or penta-exposed depending on how many of these drugs they’ve been exposed to.  

We had a study called the MAMMOTH study back – this was published back in 2019 prior to the era of CAR T cells and other T-cell directed therapies. And at the time they had looked at patients who were triple class exposed, and who had been exposed to daratumumab were refractory to daratumumab as their last line of therapy. And what we saw was with their next line of therapy or whatever else was available at the time for patients such as these, their expected response rate was only about 30 percent or so, number one.  

Two, their outlook was very poor with a median progression-free survival which means that the amount of time that patients could go without the disease coming back, and that median progression-free survival was less than six months. And their expected even median overall survival was well under a year. So, that was what the landscape looked like when CAR T cells came onto the scene. For instance, the CART2 trials, which is one of the approved products which is cilta-cel which is what we have now, we actually saw for this same group of patients, the response rates was now 98 percent.  

Deep responses were 83 percent. And we now have the final readout of their median progression-free survival which is almost three years. So, you can see a significant difference.  

Under six months, media progression-free survival to three years. And over 50 percent of the patients were living over three years. So, that’s kind of where we are at. I mean so it was no small improvement. This considerably kind of almost reset the bar and has given a new lease of hope and life to patients who had advance myeloma. And one of the things we say in myeloma is although we don’t, as yet, say that myeloma’s curable, we are working towards that. But we are also giving options for other treatments, other research to be effective in patients just by keeping them around longer.  

Katherine:

Have there been any recent research developments involving CAR T-cell therapy that patients should know about? 

Dr. Richard:

Absolutely. So, much as I have highlighted all the hope and the optimism and the good things about this, the fact is we’re still not curing people with these therapies.  

So, we called this a plateau in the survival curve which means that if we achieve that plateau, that means the disease is probably not coming back, and we have essentially the definition of cured. But we’re not seeing that. We’re still seeing a downslope in the survival curves of myeloma which means that patients are still relapsing in spite of these excellent therapies. So, there’s a lot of research going on into why are patients still relapsing? Is it because they’re losing the antigen which the CAR T cells are recognizing? Is it because the CAR T cells are no longer effective even though the antigen is still present? Is it because there’s a considerable lag time between the patients being freezed or collected, the cells being collected for the genetic modification in the lab to the time when the patients can actually receive these cells? And that can be anywhere between four to eight weeks.  

So, during this time period, patients with advanced myeloma may not remain static with their disease. The disease is progressing. They’re getting worse. They may not be candidates for these kinds of therapies. So, one of the areas of research is how can we speed up this process, this manufacture process? How can we make it much more available? Because they’re limited by the manufacturing facilities, their abilities to have these viral vectors, to be able to transduce these cells and genetically modify. So, can we take them off of those kinds of things? Can we automate this? Can we improve these manufacturing platforms? So, a lot of different things are being tested. And then as I’d also mentioned earlier, right now they’re approved for advance myeloma, but what if we can bring them up earlier? Are patients actually going to get cured by that? Are they going to have a much better progression-free survival with that versus waiting until they’re very advanced? So, these are all many, many things that are being looked at.  

In addition, a lot of these CAR T products, these approved products, all them are all recognizing one antigen on the myeloma cell. Now there are products are being looked at that are dual target antigen recognition ability. So, that’s another thing. So, maybe if the CAR T cells are missing one of the antigens, and they’re not able to use that to kill the myeloma cell, maybe the other antigen can pick up the slack. So, these are various things that are being looked at.  

Katherine:

Yeah. Well, now that we understand a bit more about what it is, let’s walk through the process.  

When a patient goes through CAR T, what happens first? 

Dr. Richard:

So, the first step is being referred to a CAR T physician. Right now, CAR T therapies can only be done in certain tertiary care institutions, not even all tertiary care institutions.   

They have to have the ability to manage and process cellular therapies. So, that’s limited right there. So, patients have to be referred to centers, so actually do these CAR T kind of therapies. Once they meet with the myeloma physician who deals with CAR Ts as well, then the way it works in our institution is then we assess them for which is the best kind of CAR T product the patient may be eligible for. Are they eligible for clinical trials? Do they fit the profile for clinical trial? Are the patients willing for clinical trails? If not, are they candidates for one of the commercially approved products? As I said, there is specific criteria. Patients have to have had at least four lines of therapy to be able to receive a commercially approved CAR T product.  

If that is the case, and once the process has been explained to the patient, they have to go through all the financials, the insurance approval. These are very expensive propositions. So, the insurance goes through all of the criteria to make sure that they will approve the product. Once the insurance approves, they also going through the institutional approval process to make sure that these are again being done for the right patient, and that they go through the institutional approval. There are several patient specific characteristics.

For instance, we want a patient who has the support structure to be able to support a therapy like this. They have to have a good performance status. They have to be relatively able to be able to handle these kinds of therapies. I went through all of those side effects that are possible. We look at their cardiac status. We look at the neurological status.  

We look at the pace at which their disease is escalating because these are again advanced patients. So, if somebody is relapsing very quickly, they may not have the time to wait to get to a slot for the apheresis, and then to wait again for the manufacturing to happen. So, we look at all of that. We look at their kidney function. And then finally in terms of their psychosocial, do they have their caretakers, the support system? Where do they live? Are they able to access our center? Are they from out of state? If so, how are we going to manage during those initial months until they’re able, stable enough to be discharged back to their referring physician?

So, we look at several things, so we have multiple teams of people, social work, pharmacy who looks at all of these different – and explains the pharmaceutical aspects of all of this, our finance team, our coordinators who put all of this together.  For the apheresis, we are involved with a apheresis team.   

And then the cell therapy lab that processes the cells, the vascular team to put in the lines required for the apheresis. So, there are several, several groups. And then if we need to get a consultation from our expert cardiologist or neurooncologist, we need to have those teams involved as well.  

Katherine:

How long does it take to know whether the treatment has been successful? 

Dr. Richard:

So, we get a sense depending on what their blood markers look like, we can get a sense within the first month if the patient is actually responding to the treatment or not. I generally wait for the first three months to do a actual formal assessment with their bone marrow and their PET scans and everything else because right around then they’ve gone through the initial acute post CAR T period. And so, at the time of the bone marrow we assess what it looks like, we send for a test called MRD which is minimal residual disease to see where they’re at with that. 

And PET scans to look at any areas of skeletal lesions or even extramedullary disease that they may have. So, I would say within the first month we get a sense, but by three months we do that first formal assessment.  

Katherine:

You mentioned the role of the care partner, and you’ve talked about the recovery process and how involved it is. What do you feel is the care partner’s role in helping a patient through the process? 

Dr. Richard:

I think much of it is emotional and psychological support. I think that is very, very key. But in terms of actually what they do, we do ask that they have a caretaker available 24/7 if possible at least for the first month or so following their CAR T. And this is because they need a lot of support going back and forth from wherever they’re residing whether it’s a hotel or whether it’s their own home because there are a lot of clinic visits during that time.  

We do ask that the patients don’t drive for at least the first month, maybe even the first couple of months following the CAR T because again they can have neurological side effects that may be somewhat subtle. Their judgement may be impaired, but they may not look that different. So, a caretaker who knows them well is very useful in saying, “There’s something weird about how Joe’s acting lately,” or something like that.

So, that’s very important as well to bring them back and forth and to manage all of these. And if there’s a problem in the middle of the night, if they’re having new fevers, they’re suddenly neurologically altered, they do need a person to be able to handle things and bring them in and get the adequate medical support.  

Katherine:

What questions should care partners be asking if they begin the process? 

Dr. Richard:

I think a good understanding of all of those.  

So, whatever that takes for each individual person. We have patients of various different kinds who have come to us, some who have researched it and really know what’s going on out there, and others who are comparatively, “What is this CAR T thing? We have no idea what this is all about.” So, I meet each one where they are. I go over the entire process. I touch on all the different things that we just spoke about. I talk about the logistics of it. I talk about the timing. One of the traffic jams is being able to get that initial fresis slot to be able to even send the cells to the manufacturing.

So, there’s a question of managing the resources and making sure that patients are getting to their CAR T slots in a timely manner. So, a good part of it is an understanding that all of this is not something that happens overnight. There is several moving parts. There is a way, and their system, and a way that all of these have to be aligned.  

So, I pretty much answer whatever they have, but I think questions touching on all of this. And finally, they exact thing that you asked, “How is it that they can help? What are the things that they can do to help?” And I think that is hugely important as well.   

Katherine:

Yeah. Why is it so important that care partners let the care team know about any changes in the patient? 

Dr. Richard:

I think the earlier we know of changes, the better. We can handle these things. There is a time sensitivity to a lot of this. If issues that happen are not addressed right away, they can evolve to more severe condition. And once if they’re more severe, they’re less likely to respond right away to the therapeutic maneuvers that we have. So, I think that’s really important.  

And if they’re outpatient, we do bring them in for hospitalization right away. If there is anything that is – the delayed forms of these side effects can sometimes be also a little bit harder to resolve and turn around. So, it’s important that they come back to the hospital right away, get admitted for the workup, so that we can escalate the speed at which things can be done.  

Katherine:

Being a care partner can be overwhelming at times. Do you have any advice to help care partners as they cope with their role? 

Dr. Richard:

There’s a lot of support groups. I really encourage them to start talking to a social worker right away. So, our social workers really do get engaged in the process pretty early. There are many different kinds of support groups. There are support groups that are myeloma specific, and then support groups within those that are offshoots for CAR T patients, so people either thinking of going through a CAR T or in the middle of it or even post CAR T.  

All the anxiety of the monitoring and, “Is the disease going to come back?” And that can weigh heavily on the caretaker as well. So, an emotionally supported caretaker and patient just makes it a lot easier for everybody including the medical care teams to be able to handle all of this.   

Katherine:

We have a few questions that are community sent in prior to the program. I’d like to start with Melissa’s question. “Do you have any advice for handling the emotional highs and lows as well as personality changes within the relationship?”  

Dr. Richard:

That can be a challenging one. And as medical doctors, we tend to not be the best people to usually – and so what I really draw on is social work and our coordinator’s support for that kind of thing. At our institution we have a affiliate of care of supportive care oncology team who help with a lot of the symptom management or anything like that. 

And if it’s something that actually needs more than just counseling, if they actually need medications, then we have our psychiatric oncology groups who also help with a lot of those. So, I think being prepared for any of these is important, but I think a lot can be handled just by having a good adequate support of care that starts right at the beginning of the process before things start getting overwhelming.  

Katherine:

Yeah. Here’s another question we received: What kind of nutrition does a patient need during this process? And how can the care giver ensure adequate nutritional support? 

Dr. Richard:

So, among our various teams, we have actually a nutritionist who actually meets with the patient about the time of their discharge from the hospital. And they give them a lot of guidelines about how to handle various dietary things.  

In general, going into CAR T, a well-balanced healthy diet is always a good thing. Maintain your diet well as much as possible. Following the CAR T process, we do follow guidelines for what we call a neutropenic diet wherein well-cooked meats are preferable to anything undercooked because that’s where you can have a lot of bacteria. We advise against raw or undercooked meats of all kinds. Pasteurized foods obviously much better than don’t go for the unpasteurized. Don’t go for the soft cheeses which tends to be unpasteurized or typical wherein you can have – and also in terms of nuts, prefer the roasted nuts rather than the raw nuts and things like that. So, any fruits and vegetables, we advise that they should be well washed and cleaned. 

We advise against the thin-skinned ones that are harder to clean. We prefer rather the thick-skinned fruits where you can wash it well and then peel it. So, those have less tendency to spread diseases and bacteria and things like that. So, those are some of the things that we advise. And we do give them a dietary sheet wherein they have the dos and don’ts, but because it’s easy to forget some of these. We prefer don’t go to delis. Don’t get deli meat. So, if you like those kinds of things, get the packaged form where you can control the quality of things like that.  

Katherine:

What about something like raw fish? Is that recommended or not? 

Dr. Richard:

We prefer it not. Raw fish again like smoked fish and things like that, we prefer to avoid those things at least for the first few months after CAR T. We generally make these somewhat straight for the first three months.  

Post CAR T patients are immunosuppressed for a long time. There’s no great science at the three-month mark because I think at three months plus one day you’re probably still at some risk. And everybody’s immune recovery is different. So, patients who are immunosuppressed for a long time, I say, “Just try to stick to these unless it’s something that you really can’t do without.” But it’s much better to try to maintain these guidelines for as long as possible.  

Katherine:

Another audience member wants to know, “What is the difference between CAR T and bispecific antibody treatment?” 

Dr. Richard:

Oh, good one. So, as I mentioned, with the CAR Ts, the T cells that are taken from the patient is actually genetically modified. So, these are kind of souped-up T cells if you want to put it that way because one, they efficiently recognize that myeloma cells, and two, they are efficient killers of the myeloma cells which are the two main jobs of your T cells.  

With a bispecific antibody, this is an off the shelf thing, so this is not manufactured specifically for the patient. And then it’s a drug. And the drug has two receptors. One recognizes the myeloma cell, and the other recognizes the patient’s own T cells. So, these are unmodified T cells that just floating around. And they bring the patient’s T cells to the myeloma cell to kill it. So, that’s the difference. It’s an off the shelf product versus a manufactured. The T cells are your own. They are not manufactured in any way, but otherwise they’re kind of similar in that they’re both T-cell directed killing mechanisms, and they recognize the myeloma cell.  

Katherine:

Okay. Thank you for that. Thoughtful answers, Dr. Richard. We appreicate it. Before we end the program, I’d like to get your final thoughts. What message would you like to leave the audience with? 

Dr. Richard:

I want to leave a message of hope. I want to leave a message that there is so much research going on.  

And we couldn’t do any of these without the involvement of patients and their caregivers. And that’s how we have moved the field forward to this extent. And that’s how we continue to move the field forward. There’s a lot of reason to hope. And the Holy Grail, of course, is cure. And that’s what the entire myeloma community is working toward getting to that goal one day. So, I want to thank the patients and the caregivers for helping to move this, so helping themselves and helping others.  

Katherine:

Well, Dr. Richard, thank you so much for taking the time to join us today.  

Dr. Richard:

Thank you for having me.  

Katherine:

And thank you to all of our partners.  

If you’d like to watch this webinar again, there will be a replay available soon. You’ll receive an email when it’s ready. And don’t forget to take the survey immediately following this webinar. It will help us as we plan programs in the future. To access tools to help you become a proactive care partner, visit powerfulpatients.org.  

I’m Katherine Banwell. Thanks for being with us. 

CAR T-Cell Therapy Care Partners | Understanding Your Role in Patient Care and Recovery

CAR T-Cell Therapy Care Partners | Understanding Your Role in Patient Care and Recovery from Patient Empowerment Network on Vimeo.

Understanding CAR T-cell therapy and recovery is vital for care partners who are caring for a loved one undergoing this treatment approach. Dr. Shambavi Richard explains the CAR T-cell therapy process, potential complications, ongoing research in the field, and discusses how care partners can provide support at each stage of the process.

Bio:
Dr. Shambavi Richard is the Co-Lead Physician for the Multiple Myeloma CAR-T Program at Mount Sinai Tisch Cancer Center. Learn more about Dr. Shambavi Richard.

See More from The Care Partner Toolkit: CAR T-Cell Therapy

Related Resources:

What Resources Are Available for CAR T-Cell Therapy Care Partners

What Resources Are Available for CAR T-Cell Therapy Care Partners

Are You a CAR T-Cell Therapy Care Partner_ Why You Should Ask for Help

Are You A CAR T-Cell Therapy Care Partner? Why You Should Ask For Help

Expert Advice for CAR T-Cell Therapy Care Partners

Expert Advice for CAR T-Cell Therapy Care Partners

Transcript:

Katherine:

Today we’re going to learn about CAR T-cell therapy to help care partners understand how it works, what happens during recovery, and why care partners are so essential throughout the process. Before we meet our guest, let’s review a few important details. The reminder email you received about this program contains a link to a program resource guide. If you haven’t already, click that link to access information to follow along during the webinar. At the end of this program, you’ll receive a link to a program survey. This will allow you to provide feedback about your experience today. And it will help us plan future webinars. Finally, before we get into the discussion, please remember that this program is not a substitute for seeking medical advice. Please refer to your healthcare team about what might be best for you. Well, let’s meet our guest today.  

Joining us is Dr. Shambavi Richard. Dr. Richard, welcome. Will you please introduce yourself? 

Dr. Richard:

Hi. I’m Shambavi Richard. I am in the myeloma faculty at Mount Sinai. I’m Associate Professor of Medicine. And I codirect the CAR T and cellular therapies for myeloma at my institution.    

Katherine:

Well, thank you so much for joining us today. We really appreciate you taking the time.  

Dr. Richard:

Thanks for having me.  

Katherine:

Let’s begin with the basics of CAR T-cell therapy. What is it? And maybe, actually, we could start with what CAR is short for.  

Dr. Richard:

So, CAR stands for chimeric antigen receptors, so CAR T cell is a chimeric antigen receptor T-cell therapy. What that means is T cells, which is one of the cells for immune system are actually come from the patient. They’re expanded and activated in a manufacturing facility. And there they undergo genetic modification to form the CAR T cells. And what’s special about the CAR T cells is that they have the capacity to recognize myeloma cells and are efficient killers of the myeloma cells.   

Katherine:

Who might this approach be right for? What determines eligibility? 

Dr. Richard:

So, interestingly enough, today as we speak, CAR T cells may be eligible for many, many different kinds of – in the phases, many different phases of the myeloma journey. When they were initially tested, as most new therapies are, they were tested on patients who had very advanced myeloma, really were not candidates or did not have great options for any other kinds of therapy. And when they got tested in these groups of patients, they really had stellar results that far outstripped anything else that we had as options for patients in those advanced stages of myeloma. So, the approval for CAR T cells as they stand today for myeloma is for advance myeloma with patients who have had four or more lines of therapy and have had exposure to pretty much the major three classes of therapies for myeloma which includes proteasome inhibitors, imides, and anti-CD38 antibody therapy.  

But having said that, now CAR T cells are being moved into earlier lines of therapy are now being tested in these in various clinical trials. And even for newly diagnosed myeloma patients to see if they are as good as autologous transplants. Are they better than autologous transplants? And so on and so forth. So, really that’s what I mean by saying for now CAR T cells are appropriate for anyone if they are candidates for clinical trials. But in terms of approved indications for CAR T therapy, those are for advanced myeloma patients who have had at least four lines of therapy.  

Katherine:

Dr. Richard, what are the potential side effects or complications of CAR T-cell therapy? 

Dr. Richard:

So, there are several possible side effects with CAR T therapy.  

It’s a little different from an autologous transplants. And I bring that up just to say because they are both cellular therapies, so are frequently compared and contrasted with autologous transplants which we have had for about three decades now. So, the main side effect after CAR T therapy is something called CRS or cytokine release syndrome. So, that happens when CAR T cells recognize the myeloma cells and kill them. A host of chemicals called cytokines are released in the body. And this can make a person feel like they have a bad case of the flu. So, it may be things like fevers, chills, body pains, headaches, loss of appetite, nausea, fatigue. So, these are some common symptoms of cytokine release syndrome. But these are the milder forms, so in more severe cases of cytokine release syndrome, you can have things like drop in blood pressure, drop in oxygen levels, needing supplementation with oxygen.  

Or in terms of drop in pressure, they may need fluid resuscitation or sometimes even pressors, blood pressure medications that help to boost the blood pressure. So, that’s one major side effect. Another is something called neurotoxicity.  

So, you can have neurological side effects from CAR T therapy which when it occurs in the setting of CRS, that’s called ICANS or immune effector cell-associated neurotoxicity syndrome. That’s what that acronym stands for. And it has a constellation of symptoms such as confusion, disorientation, difficulty with some common everyday tasks. The handwriting may go off, attention deficit, things like that. But then in more severe forms of ICANS, you can actually have lethargy, coma, seizures, brain edema, so much more scary things.  

Then there is another form of toxicity called delayed neurotoxicity which looks completely different. Now you have things like Parkinson’s disease or neuropathies. Either cranial nerve neuropathies or peripheral neuropathies, Guillain-Barre which is a kind of ascending paralysis. So, all of these are also possible as neurotoxic side effects from CAR T therapy. Aside from these, there is another which is called HLH or macrophage activation syndrome or hemophagocytic lymphohistiocytosis syndrome wherein patients can have organ toxicity, a spiking ferritin levels, new fevers, new neurotoxic symptoms, additional lab abnormalities such as liver function test abnormalities. So, these are other forms of just general CAR T-cell toxicity.  

Then in addition to these, you can have infections, prolonged blood count abnormalities, cytopenia as we call it which can affect the white cells or the platelets or anemia and things like that. So, these are also possible. And then finally things like second primary malignancies which can happen, other malignancies that can happen that may be related to CAR T therapy. A lot of these are still being studied. We don’t have a good understanding of how frequently this happens. But these are all possible side effects of CAR T therapy.  

Katherine:

Do any of the complications have to result in hospitalization? Or can patients be treated outside the hospital? 

Dr. Richard:

So, the way things stand now, and this may be slightly different depending on the specific CAR T product.  

But we generally keep patients hospitalized for the first two weeks after the cell infusion. Most of the side effects such as the CRS and the ICANS tends to occur during this hospitalization phase. HLH and delayed neurotoxicities can occur while they’re still in the later phases of the hospitalization, or it can occur late after they get discharged from the hospital. Infections and cytopenias of course can happen for a while following CAR T therapy. Once they are discharged from the hospital, we ask that they stay close to us, usually within an hour or two of the hospital so that they can quickly come back in if there’s any issues. We see them quite frequently once they get discharged from the hospital. I see them at a minimum of once a week, more frequently at least a couple times a week, or even three times a week depending on what their blood count needs and monitoring needs are.   

So, we have them stay close to the hospital if they are far away. And the sponsor and our social worker, insurance can work together to figure out how to help them with the hotel costs if they have to stay close to us. So, that’s for an additional two weeks after they’ve discharged from the hospital. Following that, patients go back to their homes, but we still follow them quite frequently depending on what their needs are in terms of possible side effects.   

Katherine:

Dr. Richard, how is CAR T-cell therapy impacting the landscape of myeloma care?  

Dr. Richard:

So, as I’d hinted or alluded to previously, prior to CAR T cells appearing on the horizon, we had very limited options for patients who had had the first several lines of therapy.  

So, once they had been exposed to two proteasome inhibitors, two iMiDs, and then anti-CD38 antibody which is the three major class of myeloma drugs, they are then called triple class exposed or penta-exposed depending on how many of these drugs they’ve been exposed to.  

We had a study called the MAMMOTH study back – this was published back in 2019 prior to the era of CAR T cells and other T-cell directed therapies. And at the time they had looked at patients who were triple class exposed, and who had been exposed to daratumumab were refractory to daratumumab as their last line of therapy. And what we saw was with their next line of therapy or whatever else was available at the time for patients such as these, their expected response rate was only about 30 percent or so, number one.  

Two, their outlook was very poor with a median progression-free survival which means that the amount of time that patients could go without the disease coming back, and that median progression-free survival was less than six months. And their expected even median overall survival was well under a year. So, that was what the landscape looked like when CAR T cells came onto the scene. For instance, the CART2 trials, which is one of the approved products which is cilta-cel which is what we have now, we actually saw for this same group of patients, the response rates was now 98 percent.  

Deep responses were 83 percent. And we now have the final readout of their median progression-free survival which is almost three years. So, you can see a significant difference.  

Under six months, media progression-free survival to three years. And over 50 percent of the patients were living over three years. So, that’s kind of where we are at. I mean so it was no small improvement. This considerably kind of almost reset the bar and has given a new lease of hope and life to patients who had advance myeloma. And one of the things we say in myeloma is although we don’t, as yet, say that myeloma’s curable, we are working towards that. But we are also giving options for other treatments, other research to be effective in patients just by keeping them around longer.  

Katherine:

Have there been any recent research developments involving CAR T-cell therapy that patients should know about? 

Dr. Richard:

Absolutely. So, much as I have highlighted all the hope and the optimism and the good things about this, the fact is we’re still not curing people with these therapies.  

So, we called this a plateau in the survival curve which means that if we achieve that plateau, that means the disease is probably not coming back, and we have essentially the definition of cured. But we’re not seeing that. We’re still seeing a downslope in the survival curves of myeloma which means that patients are still relapsing in spite of these excellent therapies. So, there’s a lot of research going on into why are patients still relapsing? Is it because they’re losing the antigen which the CAR T cells are recognizing? Is it because the CAR T cells are no longer effective even though the antigen is still present? Is it because there’s a considerable lag time between the patients being freezed or collected, the cells being collected for the genetic modification in the lab to the time when the patients can actually receive these cells? And that can be anywhere between four to eight weeks.  

So, during this time period, patients with advanced myeloma may not remain static with their disease. The disease is progressing. They’re getting worse. They may not be candidates for these kinds of therapies. So, one of the areas of research is how can we speed up this process, this manufacture process? How can we make it much more available? Because they’re limited by the manufacturing facilities, their abilities to have these viral vectors, to be able to transduce these cells and genetically modify. So, can we take them off of those kinds of things? Can we automate this? Can we improve these manufacturing platforms? So, a lot of different things are being tested. And then as I’d also mentioned earlier, right now they’re approved for advance myeloma, but what if we can bring them up earlier? Are patients actually going to get cured by that? Are they going to have a much better progression-free survival with that versus waiting until they’re very advanced? So, these are all many, many things that are being looked at.  

In addition, a lot of these CAR T products, these approved products, all them are all recognizing one antigen on the myeloma cell. Now there are products are being looked at that are dual target antigen recognition ability. So, that’s another thing. So, maybe if the CAR T cells are missing one of the antigens, and they’re not able to use that to kill the myeloma cell, maybe the other antigen can pick up the slack. So, these are various things that are being looked at.  

Katherine:

Yeah. Well, now that we understand a bit more about what it is, let’s walk through the process.  

When a patient goes through CAR T, what happens first? 

Dr. Richard:

So, the first step is being referred to a CAR T physician. Right now, CAR T therapies can only be done in certain tertiary care institutions, not even all tertiary care institutions.   

They have to have the ability to manage and process cellular therapies. So, that’s limited right there. So, patients have to be referred to centers, so actually do these CAR T kind of therapies. Once they meet with the myeloma physician who deals with CAR Ts as well, then the way it works in our institution is then we assess them for which is the best kind of CAR T product the patient may be eligible for. Are they eligible for clinical trials? Do they fit the profile for clinical trial? Are the patients willing for clinical trails? If not, are they candidates for one of the commercially approved products? As I said, there is specific criteria. Patients have to have had at least four lines of therapy to be able to receive a commercially approved CAR T product.  

If that is the case, and once the process has been explained to the patient, they have to go through all the financials, the insurance approval. These are very expensive propositions. So, the insurance goes through all of the criteria to make sure that they will approve the product. Once the insurance approves, they also going through the institutional approval process to make sure that these are again being done for the right patient, and that they go through the institutional approval. There are several patient specific characteristics.

For instance, we want a patient who has the support structure to be able to support a therapy like this. They have to have a good performance status. They have to be relatively able to be able to handle these kinds of therapies. I went through all of those side effects that are possible. We look at their cardiac status. We look at the neurological status.  

We look at the pace at which their disease is escalating because these are again advanced patients. So, if somebody is relapsing very quickly, they may not have the time to wait to get to a slot for the apheresis, and then to wait again for the manufacturing to happen. So, we look at all of that. We look at their kidney function. And then finally in terms of their psychosocial, do they have their caretakers, the support system? Where do they live? Are they able to access our center? Are they from out of state? If so, how are we going to manage during those initial months until they’re able, stable enough to be discharged back to their referring physician?

So, we look at several things, so we have multiple teams of people, social work, pharmacy who looks at all of these different – and explains the pharmaceutical aspects of all of this, our finance team, our coordinators who put all of this together.  For the apheresis, we are involved with a apheresis team.   

And then the cell therapy lab that processes the cells, the vascular team to put in the lines required for the apheresis. So, there are several, several groups. And then if we need to get a consultation from our expert cardiologist or neurooncologist, we need to have those teams involved as well.  

Katherine:

How long does it take to know whether the treatment has been successful? 

Dr. Richard:

So, we get a sense depending on what their blood markers look like, we can get a sense within the first month if the patient is actually responding to the treatment or not. I generally wait for the first three months to do a actual formal assessment with their bone marrow and their PET scans and everything else because right around then they’ve gone through the initial acute post CAR T period. And so, at the time of the bone marrow we assess what it looks like, we send for a test called MRD which is minimal residual disease to see where they’re at with that. 

And PET scans to look at any areas of skeletal lesions or even extramedullary disease that they may have. So, I would say within the first month we get a sense, but by three months we do that first formal assessment.  

Katherine:

You mentioned the role of the care partner, and you’ve talked about the recovery process and how involved it is. What do you feel is the care partner’s role in helping a patient through the process? 

Dr. Richard:

I think much of it is emotional and psychological support. I think that is very, very key. But in terms of actually what they do, we do ask that they have a caretaker available 24/7 if possible at least for the first month or so following their CAR T. And this is because they need a lot of support going back and forth from wherever they’re residing whether it’s a hotel or whether it’s their own home because there are a lot of clinic visits during that time.  

We do ask that the patients don’t drive for at least the first month, maybe even the first couple of months following the CAR T because again they can have neurological side effects that may be somewhat subtle. Their judgement may be impaired, but they may not look that different. So, a caretaker who knows them well is very useful in saying, “There’s something weird about how Joe’s acting lately,” or something like that.

So, that’s very important as well to bring them back and forth and to manage all of these. And if there’s a problem in the middle of the night, if they’re having new fevers, they’re suddenly neurologically altered, they do need a person to be able to handle things and bring them in and get the adequate medical support.  

Katherine:

What questions should care partners be asking if they begin the process? 

Dr. Richard:

I think a good understanding of all of those.  

So, whatever that takes for each individual person. We have patients of various different kinds who have come to us, some who have researched it and really know what’s going on out there, and others who are comparatively, “What is this CAR T thing? We have no idea what this is all about.” So, I meet each one where they are. I go over the entire process. I touch on all the different things that we just spoke about. I talk about the logistics of it. I talk about the timing. One of the traffic jams is being able to get that initial fresis slot to be able to even send the cells to the manufacturing.

So, there’s a question of managing the resources and making sure that patients are getting to their CAR T slots in a timely manner. So, a good part of it is an understanding that all of this is not something that happens overnight. There is several moving parts. There is a way, and their system, and a way that all of these have to be aligned.  

So, I pretty much answer whatever they have, but I think questions touching on all of this. And finally, they exact thing that you asked, “How is it that they can help? What are the things that they can do to help?” And I think that is hugely important as well.   

Katherine:

Yeah. Why is it so important that care partners let the care team know about any changes in the patient? 

Dr. Richard:

I think the earlier we know of changes, the better. We can handle these things. There is a time sensitivity to a lot of this. If issues that happen are not addressed right away, they can evolve to more severe condition. And once if they’re more severe, they’re less likely to respond right away to the therapeutic maneuvers that we have. So, I think that’s really important.  

And if they’re outpatient, we do bring them in for hospitalization right away. If there is anything that is – the delayed forms of these side effects can sometimes be also a little bit harder to resolve and turn around. So, it’s important that they come back to the hospital right away, get admitted for the workup, so that we can escalate the speed at which things can be done.  

Katherine:

Being a care partner can be overwhelming at times. Do you have any advice to help care partners as they cope with their role? 

Dr. Richard:

There’s a lot of support groups. I really encourage them to start talking to a social worker right away. So, our social workers really do get engaged in the process pretty early. There are many different kinds of support groups. There are support groups that are myeloma specific, and then support groups within those that are offshoots for CAR T patients, so people either thinking of going through a CAR T or in the middle of it or even post CAR T.  

All the anxiety of the monitoring and, “Is the disease going to come back?” And that can weigh heavily on the caretaker as well. So, an emotionally supported caretaker and patient just makes it a lot easier for everybody including the medical care teams to be able to handle all of this.   

Katherine:

We have a few questions that are community sent in prior to the program. I’d like to start with Melissa’s question. “Do you have any advice for handling the emotional highs and lows as well as personality changes within the relationship?”  

Dr. Richard:

That can be a challenging one. And as medical doctors, we tend to not be the best people to usually – and so what I really draw on is social work and our coordinator’s support for that kind of thing. At our institution we have a affiliate of care of supportive care oncology team who help with a lot of the symptom management or anything like that. 

And if it’s something that actually needs more than just counseling, if they actually need medications, then we have our psychiatric oncology groups who also help with a lot of those. So, I think being prepared for any of these is important, but I think a lot can be handled just by having a good adequate support of care that starts right at the beginning of the process before things start getting overwhelming.  

Katherine:

Yeah. Here’s another question we received: What kind of nutrition does a patient need during this process? And how can the care giver ensure adequate nutritional support? 

Dr. Richard:

So, among our various teams, we have actually a nutritionist who actually meets with the patient about the time of their discharge from the hospital. And they give them a lot of guidelines about how to handle various dietary things.  

In general, going into CAR T, a well-balanced healthy diet is always a good thing. Maintain your diet well as much as possible. Following the CAR T process, we do follow guidelines for what we call a neutropenic diet wherein well-cooked meats are preferable to anything undercooked because that’s where you can have a lot of bacteria. We advise against raw or undercooked meats of all kinds. Pasteurized foods obviously much better than don’t go for the unpasteurized. Don’t go for the soft cheeses which tends to be unpasteurized or typical wherein you can have – and also in terms of nuts, prefer the roasted nuts rather than the raw nuts and things like that. So, any fruits and vegetables, we advise that they should be well washed and cleaned. 

We advise against the thin-skinned ones that are harder to clean. We prefer rather the thick-skinned fruits where you can wash it well and then peel it. So, those have less tendency to spread diseases and bacteria and things like that. So, those are some of the things that we advise. And we do give them a dietary sheet wherein they have the dos and don’ts, but because it’s easy to forget some of these. We prefer don’t go to delis. Don’t get deli meat. So, if you like those kinds of things, get the packaged form where you can control the quality of things like that.  

Katherine:

What about something like raw fish? Is that recommended or not? 

Dr. Richard:

We prefer it not. Raw fish again like smoked fish and things like that, we prefer to avoid those things at least for the first few months after CAR T. We generally make these somewhat straight for the first three months.  

Post CAR T patients are immunosuppressed for a long time. There’s no great science at the three-month mark because I think at three months plus one day you’re probably still at some risk. And everybody’s immune recovery is different. So, patients who are immunosuppressed for a long time, I say, “Just try to stick to these unless it’s something that you really can’t do without.” But it’s much better to try to maintain these guidelines for as long as possible.  

Katherine:

Another audience member wants to know, “What is the difference between CAR T and bispecific antibody treatment?” 

Dr. Richard:

Oh, good one. So, as I mentioned, with the CAR Ts, the T cells that are taken from the patient is actually genetically modified. So, these are kind of souped-up T cells if you want to put it that way because one, they efficiently recognize that myeloma cells, and two, they are efficient killers of the myeloma cells which are the two main jobs of your T cells.  

With a bispecific antibody, this is an off the shelf thing, so this is not manufactured specifically for the patient. And then it’s a drug. And the drug has two receptors. One recognizes the myeloma cell, and the other recognizes the patient’s own T cells. So, these are unmodified T cells that just floating around. And they bring the patient’s T cells to the myeloma cell to kill it. So, that’s the difference. It’s an off the shelf product versus a manufactured. The T cells are your own. They are not manufactured in any way, but otherwise they’re kind of similar in that they’re both T-cell directed killing mechanisms, and they recognize the myeloma cell.  

Katherine:

Okay. Thank you for that. Thoughtful answers, Dr. Richard. We appreicate it. Before we end the program, I’d like to get your final thoughts. What message would you like to leave the audience with? 

Dr. Richard:

I want to leave a message of hope. I want to leave a message that there is so much research going on.  

And we couldn’t do any of these without the involvement of patients and their caregivers. And that’s how we have moved the field forward to this extent. And that’s how we continue to move the field forward. There’s a lot of reason to hope. And the Holy Grail, of course, is cure. And that’s what the entire myeloma community is working toward getting to that goal one day. So, I want to thank the patients and the caregivers for helping to move this, so helping themselves and helping others.  

Katherine:

Well, Dr. Richard, thank you so much for taking the time to join us today.  

Dr. Richard:

Thank you for having me.  

Katherine:

And thank you to all of our partners.  

If you’d like to watch this webinar again, there will be a replay available soon. You’ll receive an email when it’s ready. And don’t forget to take the survey immediately following this webinar. It will help us as we plan programs in the future. To access tools to help you become a proactive care partner, visit powerfulpatients.org.  

I’m Katherine Banwell. Thanks for being with us. 

Thoughts on Survivorship

Wellbeing

When the hotel alarm sounded on July 31, 2023, I woke up, put both feet on the floor, brushed my teeth, laced a pair of work boots, and caught an Uber to a factory in Potrero Hill of San Francisco.  On this work trip, with my team, we operated water treatment equipment that morning and then had lunch at a taco truck. After more work and a team dinner at a Japanese restaurant, another Uber whisked me back to the hotel in time to catch the impressive sunset over the Golden Gate Bridge.

As the sun reflected off San Francisco Bay I reflected on the past 27 years.  You see, July 31 marks my cancerversary, in other words the date that the doctor finally told me, “You no longer have cancer,” and that date marked 27 years since that discussion when I was a college student in the 90’s.

A handful of my friends know the date and sent well wishes, and on that date, old memories of my experience with Hodgkin’s Disease and prior cancerversaries have their way of returning to top of mind. I remember wanting cancer out of my body so badly and the desire to live and healthy and happy life thereafter; today we call this wellbeing.

I thought about those first steps after my doctor’s good news. Walking out of his office as a newly minted survivor felt like heading out on a journey without a map.  He had prescribed a regimen of scans, bloodwork, and follow ups which would gradually lighten as time progressed.

I dutifully followed, attended, and completed these appointments and every time sweated the results of each of them.  The new normal felt a lot more uncertain than it did before cancer. To live a healthy life as a survivor means taking on the hard stuff like waiting on results, but it also provides a level of comfort knowing the course of tests monitored my body very closely. Over time, the intervals between these exams lengthened from three months to six months. Then annually. Then never again after year 10.

Like many survivors, cancer influenced my health decisions, especially diet and exercise, to live a life with wellbeing.  Healthy habits have to underpin decisions. For me this meant getting into running and swimming. I remember running about six months after finishing treatments and could not make it 50 yards.

Sticking with good habits, stacking wins, will help healing and mental wellbeing. Whether you aim for mountain peaks or marathon finish lines, or you start a daily walking habit, movement and mobility will help the body bounce back; this worked for me.  I kept getting out there day-after-day, doing those 50-yard runs which eventually stretched further. Let your body guide you; listen; just move.

Over the years, having met so many other survivors, handling cold and flu season after cancer has some challenges. I remember the Fall after my treatments concluded, I came down with the sniffles and immediately thought cancer had returned.  Taking it a step further, I twisted my ankle on a jog about four months after finishing treatments and thought that my ankle now had cancer. It didn’t.  Relearning and listening to your body take time and those reactions are something I think all survivors experience.

One health dilemma I faced early on after the end of treatment happened in college.  The social scene at my (and many) colleges involved parties and bars. I enjoyed going to these, not so much for the alcohol but for the camaraderie. At the time (the 90’s), you could smoke in bars.  After standing in the smoke- filled college bars a few times and still worried about a relapse, I decided to change my approach. Instead of tolerating the environment, I would arrange meetups with friends earlier and would leave if it got smoky. Though I may have missed out on some late-night revelry, it meant prioritizing health first. Making this and other tradeoffs like it over the years have led to a healthier overall life without the worry of deprioritizing my health.

As the sun went down over the San Francisco Bay and the memories receded for another year, the second lifetime of chances left me with a warm appreciation of life and a gratitude for a second opportunity knowing that when the alarm sounds on the next ordinary day, August 1, I have the chance to keep going.

Good health to you.

October 2023 Notable News

This month, education and research come together to treat cancer. The three hardest to detect cancers are broken down into the most common symptoms to watch out for. Scientific research has found that a strand of RNA may be the key to using our own immune system to treat cancer. A new immunotherapy has been created to use two mechanisms to enhance our own immune system to kill cancer.

The 3 Most “Undetectable” Cancers Revealed- and How to Spot Them Before it’s Too Late

Other forms of the disease can form and grow undetected for 10 years or more as one study found, making treatment that much more difficult. It’s not that these cancers have no symptoms at all, rather the initial symptoms are similar to that of other less serious health conditions reports The US Sun. The earlier cancer is detected and treated, the better the outcome. The three cancers discussed in this article are bowel cancer, pancreatic cancer, and ovarian cancer. Signs of bowel cancer include blood in stool or changes to bowel movements such as diarrhea or constipation. Some other signs of this cancer are sudden weight loss and abdominal or rectal pain. There are very few early signs in bowel cancer. In pancreatic cancer there is a very high mortality rate. Signs of pancreatic cancer are abdominal pain, back pain, weight loss, changes in bowel movements, vomiting, and jaundice. Ovarian cancer is a very common cancer and early detection is extremely important for survival. Most symptoms of ovarian cancer show in later stages due to it spreading. Signs to watch for are changes in bowel habits such as constipation and diarrhea. Click here for the full story.

Scientists Discover a Small Strand of RNA to be Key to Fighting Cancer with Our Immune System

A team of researchers at the University of Massachusetts Amherst has shown how a single, small strand of microRNA, known as let-7, governs the ability of T cells to recognize and remember tumor cells. This cellular memory is the basis for how vaccines work. Boosting cellular memory to recognize tumors could help improve cancer therapies reports Goodnews Network. T cells get activated when a pathogen like a virus enters the body. The T cells then become killer cells to get rid of the pathogen. Most T cells die off, but some remain to be turned on later if that pathogen is reintroduced into the body. These memory cells live for a long time. This is how vaccines work. A small amount of pathogen is injected causing this mechanism to occur. Cancer causes the T cells to turn off before they can attack the cancer cells or create a memory of the cells. This allows the cancer cells to metastasize. Scientists are hoping that this new knowledge can lead to developing better immunotherapy treatments for cancer. Click here for the full story.

Double Trouble for Cancer Tumors: The Dual-Action Immunotherapy Breakthrough

Cancer immunotherapy drugs called PD-1 inhibitors are widely used to stimulate the immune system to fight cancer, but many patients either don’t respond or develop resistance to them. A new small molecule drug candidate being tested in an early-stage clinical trial aims to improve patient responses to immunotherapy reports SciTech Daily. This drug uses two mechanisms to slow the growth of tumors and increase patient survival. The small molecule drug increases immune sensitivity and immune cell activity. It blocks certain proteins, thereby making T cells and natural killer cells more effective at killing the tumor. At the same time, it makes the tumor more susceptible to the attack. Scientists hope by studying signal pathways they can find more advances for immunotherapy resistant cancers. Click here for the full story.

September 2023 Digital Health Roundup

Technology is helping doctors save cancer patients during treatment and with brand new treatments. Remote patient monitoring is detecting neutropenic fevers early in patients undergoing cancer treatments. Scientists have developed a micro device to implant inside tumors to help treat brain gliomas. With the use of CRISPR, researchers have developed a way to reprogram cancer cells into healthy muscle cells.

How Remote Patient Monitoring Can Save Cancer Patients’ Lives

Neutropenic fever is a common complication for cancer patients undergoing chemotherapy. In fact, one out of every 29 chemotherapy-treated patients is hospitalized, with a startling mortality rate of 7 to 9.5% reports Healthcare IT News. Remote patient monitoring devices include wearable temperature sensors, heartrate monitors, and respiratory rate monitors. Neutropenic fever is a common side effect of chemotherapy, but it can be serious or even fatal. This remote patient monitoring can detect fevers without symptoms or that occur during sleep. It is a simple patch that is Bluetooth enabled and transmits the data constantly. The neutropenic event caught early enough can prevent a hospital admission. Early detection of neutropenic events will improve patient outcomes and decrease the cost of admission by prevention. This success of the remote patient monitoring depends on the training of the monitoring staff. The staff must be able to recognize early warning signs of neutropenic events and respond quickly. Click here for the full story.

Microdevices Implanted into Tumors Offer New Way to Treat Brain Cancer

The shape and size of a grain of rice, the new device can conduct dozens of experiments at once to study the effects of new treatments on some of the hardest-to-treat brain cancers reports Medical Design & Development. Researchers from Brigham and Women’s Hospital designed this micro device to treat gliomas which are brain and spinal cord tumors. It monitors the effects of drugs on the tumors while surgically implanted during the treatment and it is removed before the surgery is over. This device helps to monitor the use of combination therapies and its effects on the tumor. It is implanted for two to three hours while tiny doses of drugs are given, up to 20 different drugs. The data and surrounding tissue are analyzed to learn if the drugs are effective on the tumor’s microenvironment. During the studies, there have been no adverse effects on the patient from the device. Click here for the full story.

CRISPR Used to ‘Reprogram’ Cancer Cells into Healthy Muscle in the Lab

The study published August 28 in the journal PNAS, Researchers found that disabling a particular protein complex in cells of rhabdomyosarcoma (RMS)- a rare cancer in skeletal muscle tissue that mainly effects children under age 10- in the laboratory causes the tumor cells to turn into healthy muscle reports Live Science. Differentiation therapy is the act of changing cancer cells into healthy cells and has been used for blood and bone cancers. This therapy uses CRISPR technology to alter proteins to stop cancer multiplication and can eventually be used as a treatment option. In RMS, a genetic mutation makes a protein that causes the skeletal muscles to turn into cancerous tissue. CRISPR was used to disable certain genes to stop this mutation process, and then turned the cancerous cells into healthy cells. Click here for the full story.

September 2023 Notable News

This month scientists are making strides fighting cancer in the laboratory. By altering mRNA in the lab, scientists developed a new cancer therapy that stops cancer growth. A new two system approach using CART Tcell therapy has also been developed as a cancer treatment. Finally, and equally as important, a recent study reveals a surge in people under the age of 50 are being diagnosed with cancer, showing the need for further action.

Scientists Develop New Cancer Therapy that Stop Tumor Growth in Its Tracks

Researchers from Purdue University have developed a novel cancer treatment that deceives cancer cells into absorbing a snippet of RNA that naturally blocks cell division. A study recently published in Oncogene reveals that over a 21-day. Tumor subjected to this treatment remained unchanged in size, whereas untreated tumors grew threefold reports SciTechDaily. This treatment also causes suppression of three other genes that cause cancers to grow and resist other treatments. Micro RNA-34a was modified in a lab to not be broken down by the body rapidly. The modified mRNA-34a is not detected or destroyed by the immune system. It is attached to folate, a vitamin that binds to all cells. Cancer cells have more folate receptors than other cells. MRNA 34a is drawn into cancer cells where it slows cell division. This cancer therapy is currently in mouse trials. Click here for full story.

Two-pronged Immunotherapy Approach Could Treat Most Blood Cancers

Working in mice, the scientists sicced the immune cells on a protein common to nearly all cancerous blood cells. Because that protein is also found on normal blood forming stem cells, The team also replaced those vital cells with ones genetically tweaked to be invisible to the cancer fighters. comma protecting them from onslaught reports Science. In mice, they used this CAR Tcell approach to treat AML (Acute myeloid leukemia). Scientists develop CART Tcells with a receptor for certain cancer cells and inject them into the cancer patient. This type of therapy is used for five types of blood cancers. Normal blood cells carry a certain gene that is also in the cancer cells, so scientists have altered the CART Tcells genetic code to avoid harming the normal blood cells. They can use the CART Tcell therapy and stem cell transplant for effective treatment. Further animal testing is upcoming. This treatment could be developed as a broader treatment for blood cancers. Click here for full story.

Researchers See Surge in Number of People Under 50 Diagnosed with Cancer

Globally, new cancer cases among people younger than 50 increased by 79.1% from 1990 to 2019, according to a new study published in BMJ Oncology. The number of early onset cancer deaths also increased by 27.7% from 1990 to 2019 reports The Hill. Breast, tracheal, lung, stomach and colorectal cancers have the highest mortality rate. Nasopharyngeal and prostate cancers showed the fastest increase in numbers. The results of this study show the importance of the need for targeted early detection measures. It also revealed increased risk factors in dietary choices, alcohol use, and tobacco use. Lifestyle factors such as air pollution, early life environmental exposures, and gut microbiome are all being studied. Early onset cancer numbers are also on the rise, due to early screening. Click here for the full story.

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August 2023 Digital Health Roundup

This month advances in technology aid doctors and scientists in the fight against cancer. Microbubbles armed with oxygen and a cancer drug are having positive results in mice trials. Scientists have developed robotic tentacles to assist doctors with lung cancer treatment. A new ultrasound scanner has been developed to screen for breast cancer.

Delivering Oxygen to Tumors May Be Key in Overcoming Radiation Resistance

A team led by researchers at Thomas Jefferson University and Drexel University has devised a strategy that combines ultrasound with microbubbles to deliver oxygen and cancer drugs to tumors. The results of a study published in the journal Pharmaceutics indicate that the method -tested in mice- primed tumors to be more vulnerable to radiation therapy, resulting in slowed tumor growth and increase survival reports Cancer Health. Radiation therapy causes hypoxia, which is a condition cancer cells grow in. Some tumors are resistant to radiotherapy because of this hypoxia. Scientists made microbubbles full of oxygen and the drug Ionidamine, that stops cancer cell metabolism. When injected into the body, it is targeted to release what it carries by use of ultrasound waves. In the trials, this method has been used for breast cancer treatment with the hope of using it on head and neck cancers. Click here to read more.

These Tiny Robotic Tentacles Could Travel into the Lungs to Treat Cancer

Scientists made robotic tentacles on the end of a bronchoscope to reach deeper into the lungs during lung cancer treatment. During the journey, magnets adapt the robot’s shape to the body’s anatomy. As it moves, both its form and position are fed back to a clinician. After reaching its destination, an embedded laser fiber can deliver localized treatment reports The Next Web. Magnets make the tentacles softer and easier to control the shape, so it conforms to the anatomy of the lungs. Early stages of lung cancer are typically treated by surgical intervention to take cancerous lung tissue. These robotic tentacles are less invasive and cause less pain and recovery time. This method makes for more precise removal of cancerous tissue, leaving behind more healthy tissue. Scientists have started testing this method on cadavers and will soon be moving to human trials. Click here to read more.

Study: Wearable Ultrasound Scanner Could Detect Breast Cancer Earlier

Researchers at the Massachusetts Institute of Technology said Friday they have developed a wearable ultrasound tracker that could detect breast cancer as at its early stages, giving it the potential to save lives reports UPI News. The new scanner is flexible and attaches to a bra. It captures images like ultrasound probes do in normal medical imaging. The scanner is portable and can easily be used from home. The openings in the patch have magnets that make it attach to a bra. The ultrasound scanner was made small so it could easily be used anywhere. This method is more comfortable than a mammogram, making more patients more willing to have the screening done. Click here to read more.

August 2023 Notable News

This month the key to cancer treatment for patients and doctors is knowledge. People diagnosed with cancer have protection in place for their job under The Americans with Disabilities Act. Scientists out of Denmark have discovered a new type of T cells that help fight cancer. During studies on a protein, GRP78, scientists discovered a new mechanism of how cancer spreads.

Protections for People with Cancer: Top 5 Things to Know About Your Rights as a Cancer Patient Under The Americans with Disabilities Act

The Americans with Disabilities Act offers protection for people battling cancer or who have a history of cancer. The federal law prohibits discrimination against qualified people with disabilities, including people diagnosed with cancer or who had cancer that is a remission. Reports SurvivorNet. Employers must make reasonable accommodations for patients undergoing cancer treatments. This accommodation includes allowing employees with cancer the ability to leave for medical appointments. It also allows them to take extra breaks as needed to take medications or if there is fatigue due to treatment. Employers can deny accommodation requests if it causes a significant expense or poor performance from the employee. Employers are not allowed to ask new job applicants if they have had cancer or have it currently. FMLA (Federal Family and Medical Leave Act) allows cancer patients to take unpaid leave and still protect their job position and their health insurance. This act also protects family members who are caring for cancer patients. Click here to read more.

Newly Discovered Superior T-cells Might Kill Tumors in Late-Stage Cancer Patients

A study out of Denmark has found new information about T-cells, which helps the body find and kill cells responsible for causing cancerous tumors. Our findings really surprised us, as nobody knew that individual T-cells could recognize cancer cells via several different cancer associated proteins simultaneously. These multi-pronged cells could respond to most types of cancer as cancers only need to express one of the aberrant targets to be identified as dangerous and killed said Andy Sewell, a professor at Cardiff University’s Division of Infection and Immunity reports Interesting Engineering. This knowledge was discovered during work on (TIL) Tumor Infiltrating Lymphocyte therapy, which uses T-cells grown in a lab to treat tumors and late-stage cancers. These multi-pronged T-cells are in the blood of patients that have survived cancer. In TIL therapy, doctors take T-cells from the tumor and then grow them in a lab to put them back in the patient’s body. Scientists hope to use this knowledge to make more immunotherapies to treat cancer. Click here to read more.

Surprising Finding: Scientists Discover New, Unexpected Mechanism of Cancer Cell Spread

During research on the protein GPR78, the protein that regulates replication of viruses and cancer growth, scientists made a new discovery. Lee and her colleagues have now made an unexpected discovery that may eventually enable scientists to protect cells from that hostile takeover. Typically, GRP78 resides in part of the cell called the endoplasmic reticulum. But when cells are under stress, the chaperone protein migrates to the cell’s nucleus, where it alters gene activities and changes the behavior of the cell, allowing the cancer cells to become more mobile and invasive reports SciTechDaily. Scientists used a high-resolution microscope and biochemical analysis to observe and confirm the new information about GRP78. They found GRP78 is involved in cell migration and invasion, which leads to a potential new cancer treatment that regulates GPR78. It was analyzed in lung, pancreatic, breast and colon cancers. These new findings also change the field of cell biology. It has enhanced knowledge about where the protein travels and what its new functions are. Click here to read more.