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Issue 19

Mini-transplants—well-tolerated by older patients and those with co-morbidities
Bone marrow transplants that use non-myeloablative conditioning regi¬mens are well tolerated by most patients who are ineligible for conventional high-dose conditioning before transplantation due to advanced age or co-morbidities.

SCCA Thoracic Oncology—best practices for lung cancer care
The largest and most experienced of its kind in the Pacific Northwest, SCCA’s Thoracic Oncology Program offers patients early detection, accurate staging, and access to the latest treatments through clinical studies and advanced technology.

National lung cancer study examines patient evidence-based care
SCCA is taking part in the American College of Surgeons Commission on Cancer National Pilot Study for ProvenCare® Lung Cancer, a major initiative that aims to assure that best practices are being followed.

CT scans reduce deaths by detecting lung cancers early
The National Cancer Institute has released results of a large-scale study showing 20 percent fewer lung cancer deaths among people who were screened with low-dose spiral computed tomography compared with those screened by chest X-ray.

Abiraterone– breakthrough treatment for advanced prostate cancer
Prostate cancer is a hormone-driven disease. Abiraterone turns off production of hormones that feed prostate tumors, and may be a breakthrough treatment for advanced prostate cancer.

More prostate cancer research news
The past year has been a busy one for SCCA’s Prostate Cancer Clinical Research Program. First, Provenge was approved, then the new chemotherapy drug Cabazitaxel, and finally Abiraterone

Alternative donor program— outstanding outcomes for unmatched donors
Only 30 percent of transplant patients have matched sibling donors. Half of the remaining 70 percent will find matched unrelated donors. That leaves 35 percent looking for alternatives.

 

Mini-transplants—well-tolerated by older patients and those with co-morbidities

Bone marrow transplants that use non-myeloablative conditioning regi¬mens are well tolerated by most patients who are ineligible for conventional high-dose conditioning before transplantation due to advanced age or co-morbidities.

Thanks to non-myeloablative, or these “mini,” transplants, there is no absolute upper age limit for bone marrow transplantation. Patients in their 60s, 70s, and 80s—as well as younger patients—now undergo non-myeloablative transplants at the Fred Hutchinson Cancer Research Center Transplant Program at SCCA. A majority—60 percent—do not have to be hospitalized during the transplant process and complete their conditioning, stem cell infusion, and recovery entirely in outpatient settings.

SCCA researchers are conducting a series of clinical trials of non-myeloablative transplants in older patients with acute myelogenous leukemia, adult high-risk acute lymphocytic leukemia, refractory chronic lymphocytic leukemia, advanced non-Hodgkin’s lymphoma, advanced Hodgkin’s lymphoma, multiple myeloma, or various myelodysplastic syndromes and either related or unrelated HLA-matched donors. Advanced age alone does not disqualify patients from participating in these trials.

To discuss treatment options for your patients with a physician transplant specialist from the Fred Hutchinson Cancer Research Center, please call our Intake Office at (206) 288-SCCA (7222) or (800) 804-8824.

 

SCCA Thoracic Oncology—best practices for lung cancer care

The largest and most experienced of its kind in the Pacific Northwest, SCCA’s Thoracic Oncology Program offers patients early detection, accurate staging, and access to the latest treatments through clinical studies and advanced technology.

Early detection through accurate screening

The Thoracic Oncology Program at SCCA is a national leader in lung cancer screening and has access to the newest technologies to achieve accurate and minimally invasive staging. Endobronchial ultrasound (EBUS) and navigational bronchoscopy allow high rates of success in tissue diagnosis and lymph node staging without surgery, and even without the risks of CT-guided percutaneous biopsy.

Staging is key

After diagnosis, a key benefit of the Thoracic Oncology Program is ensuring effective treatments through efficient, accurate staging.

"Our goal is to quickly and thoroughly evaluate patients, but to avoid doing extra tests that aren’t important to the staging or the treatment plan,” says Douglas E. Wood, MD, chief of cardiothoracic surgery at UW Medical Center.

“We know that it may not make a major difference in cancer outcomes for the therapy to start right away, but it is very important to the patient to know their prognosis and treatment plan as soon as possible. That is when they can feel some element of engagement and control after their life has been turned upside down,”
says Dr. Douglas E. Wood.

With its surgeons performing 1,500 surgeries a year, UWMC has the largest program in the western United States. This unmatched experience enables the team to achieve better outcomes, sometimes by refuting or confirming previous diagnoses, especially when there are areas of uncertainty in disease staging.

The philosophy of the thoracic oncology team is to “give the patient, not the cancer, the benefit of the doubt,” says Wood. In other words, SCCA physicians strive to prevent the tragic consequences that can occur when a patient with potentially curable cancer is treated less aggressively.

The difference is the team

With SCCA’s Thoracic Oncology Program, patients and their referring physicians can be confident that they have access to the best expertise, technology, and clinical studies in the country.

At SCCA, patients have access to a multi-disciplinary team of experts. The pulmonary medicine team offers the latest diagnostics and minimally invasive staging. Thoracic surgery provides national caliber expertise in minimally invasive surgery and surgery for advanced cancers deemed inoperable elsewhere. SCCA’s medical oncology team is the largest group of dedicated lung cancer oncologists in the Pacific Northwest, with expertise in targeted therapy for lung cancer and access to a broad spectrum of clinical studies. Radiation oncology offers sophisticated stereotactic radiation for medically inoperable patients and as an alternative to surgery for high-risk patients.

“At SCCA, we are committed to seeing a patient within a week of referral, completing staging and workup, and initiating treatment in most cases within seven days,” says Wood. “This is only possible because of a widespread commitment by our team to the “golden rule of health care”—we take care of our patients the way we would want ourselves or our loved ones to be cared for.”

Streamlined access

SCCA’s Thoracic Oncology Program offers patients streamlined access to the right specialists and the latest technology. Rather than facing a complex maze of specialists who may or may not be in contact with each other, Wood says referring physicians are able to “make one phone call and know that their patient will see the right physician the first time.”

Comprehensive access pathways ensure that patients see the correct doctor or team of doctors at the first visit, which speeds the workup and treatment planning and ensures a minimum of confusion for patients and their families. Streamlined access, combined with clear explanations from experienced physicians, helps patients feel confident during the stressful time of a cancer diagnosis To learn more about the Thoracic Oncology Program at the SCCA visit www.scca.org/thoraciconcology or call (206)288-1024.

 

National lung cancer study examines patient evidence-based care

SCCA is taking part in the American College of Surgeons Commission on Cancer National Pilot Study for ProvenCare® Lung Cancer, a major initiative that aims to assure that best practices are being followed. The goal of this study, launched in July 2010 and underway at six institutions in addition to SCCA, is to demonstrate that reliable delivery of evidence-based care for lung cancer is feasible in a multi-institutional setting and results in improved short-term outcomes (morbidity, cost, hospital length of stay, and re-admission rates).

An overall goal is to improve patient satisfaction, outcomes, and value.
Dr. Douglas E. Wood, the study’s co-leader, says important aspects of the ProvenCare® pilot are patients’ active engagement with their care team and identifying and incorporating the values of patients and their families into the treatment plan.

Look for more information about the pilot study and its results in a future issue of Leading Edge.

 

CT scans reduce deaths by detecting lung cancers early

The National Cancer Institute has released results of a large-scale study showing 20 percent fewer lung cancer deaths among people who were screened with low-dose spiral computed tomography compared with those screened by chest X-ray.

Last November, the National Cancer Institute released results of a large-scale study that looked at screening methods to reduce lung cancer deaths by detecting cancers at early stages. Results showed a definite mortality benefit with low-dose computed tomography (CT). In fact, 20 percent fewer lung cancer deaths were seen among those who were screened with low-dose spiral CT than with chest X-ray.

“For the first time in the history of lung cancer, we have results in a randomized screening trial that suggests that the mortality rate of high risk lung cancer individuals can be reduced using a screening modality,” says Jason W. Chien, MD, associate professor in the Division of Pulmonary and Critical Care at the University of Washington and associate member in the Clinical Research Division at Fred Hutchinson Cancer Research Center.

“However,” Chien continues, “much work needs to be done before this can be implemented. For instance, there are still no recommendations regarding who should be screened.”

The National Lung Screening Trial was a randomized national trial involving more than 53,000 current and former heavy smokers between ages 55 and 74. The study compared the effects of two screening procedures conducted for lung cancer—low-dose helical CT and standard chest X-ray—on lung cancer mortality. A paper describing the design and protocol of the study published in November 2010 issue of Radiology is available at http://radiology.rsna.org/cgi/content/abstract/radiol.10091808.

 

Abiraterone– breakthrough treatment for advanced prostate cancer

Prostate cancer is a hormone-driven disease. Abiraterone turns off production of hormones that feed prostate tumors, and may be a breakthrough treatment for advanced prostate cancer.

In advanced cases of metastatic prostate cancer, physicians routinely prescribe androgen deprivation treatment to cut back on the “fuel” for prostate cancer. But many men become resistant to androgen deprivation treatment, and their disease recurs.

Researchers from SCCA and UW Medicine have been trying to better understand how prostate cancer develops resistance to androgen deprivation, and to leverage that understanding to develop better therapies. The development and initial success of Abiraterone, a new drug that turns off production of tumor-feeding hormones, provides proof that prostate cancer remains androgen driven, says Bruce Montgomery, MD, associate professor in the Division of Oncology at the University of Washington. Montgomery treats patients at the SCCA and veterans’ administration hospitals.

In a Phase III randomized study in men with docetaxel refractory prostate cancer, Abiraterone showed a 35 percent improvement in survival when gauged in proportion to other therapies.

SCCA researchers are testing new agents like Arbiraterone with the idea of improving control by blocking tumor steroid metabolism and androgen receptor activation, and by suppressing androgen receptor entirely. The hope is that hormonal therapy will fulfill the promise of better surgical and radiotherapy outcomes for men in earlier stages of prostate cancer by treating both local and systemic disease.

SCCA is currently the only cancer treatment center where patients—both those in early stages of the disease and those receiving radiation treatment for more advanced stages—are receiving Abiraterone. For more information go to www.seattlecca. org/clinical-trials/prostate-cancer-list.cfm or contact Branda Levchak at (206) 598-0851.

Phase 2 Trial of Radiation with Androgen Deprivation (7048)
Phase 2 Trial of Radiation with Androgen Deprivation (RAD): Abiraterone Acetate, Prednisone and LHRH Agonist Prior to and Concurrent with Radiation Therapy.

Abiraterone Acetate (CB7630) (20091142)
A Phase 2 Open-Label, Randomized, Multi-center Study of Neoadjuvant Abiraterone Acetate (CB7630) Plus Leuprolide Acetate and Prednisone Versus Leuprolide Acetate Alone in Men With Localized High Risk Prostate Cancer.

 

More prostate cancer research news

The past year has been a busy one for SCCA’s Prostate Cancer Clinical Research Program. First, Provenge was approved, then the new chemotherapy drug Cabazitaxel, and finally Abiraterone. The prostate cancer group participated in the development of both Abiraterone and Provenge, says Celestia Higano, MD, professor in the Medical Oncology Division at the University of Washington and a member of the Clinical Research Division at the Fred Hutchinson Cancer Research Center. Higano was a member of the steering committees for both trials and participated in the design and conduct of early-stage and Phase III trials. Higano notes that results of the Provenge trial were recently published in the New England Journal of Medicine.

 

Alternative donor program— outstanding outcomes for unmatched donors

Only 30 percent of transplant patients have matched sibling donors. Half of the remaining 70 percent will find matched unrelated donors. That leaves 35 percent looking for alternatives.

“For a long time, matched, unrelated donors have been the alternative donors of choice,” says Paul O’Donnell, MD, medical director of the Adult Transplant Service at SCCA and researcher in the Clinical Research Division at Fred Hutchinson Cancer Research Center.

“Our outcomes using such donors consistently outperform other centers. Now we are able to offer those patients who can’t find a matched, unrelated donor with the options of transplants using a haploidentical donor or unrelated cord blood.”
In SCCA’s Bone Marrow Transplant Program, all three types of donations are well-developed, with many protocols in place for full and mini-transplants.

“Many centers across the country are finding that outcomes of transplants using haploidentical or cord blood donors are very similar to matched donors,” O’Donnell
says. “Surprisingly, the incidence of acute or chronic graft versus host disease are less than or similar to those of matched donors using current protocols.”

The key to success of a haploidentical transplant relies on the administration of high-dose cyclophosphamide after the transplant—a treatment O’Donnell calls “counter-intuitive.” Doses are given on days three and four post-transplant, and are followed on day five with standard immunosuppressive treatments.

“The cost of this drug is only about $300,” says O’Donnell. “It’s a wonderfully low-tech approach in our high-tech era.”

In the past, these donor options were restricted to pediatric patients. SCCA physicians, however, routinely use a combination of two cord blood units to extend the options to adult patients. “New studies, in which one of the cord blood units is grown in the lab pre-transplant, have been successful in increasing the rate of engraftment post-transplant,” O’Donnell says.

SCCA’s Alternative Donor Program provides opportunities for nearly
any patient to receive a transplant.

Read the full description of each clinical trial and enroll your patients online at www.seattlecca.org/clinical-trials/transplant-list.cfm


Adult Bone Marrow Transplant News

The SCCA Adult Bone Marrow Transplant News is a publication presenting the latest information on bone marrow transplant research at SCCA, providing up-to-date information for all health care professionals caring for transplant patients.

Pediatric Bone Marrow Transplant News

Read about important outcomes research at the Fred Hutch that may benefit your patients.

Clinical Trials Monthly

Each issue of Clinical Trials Monthly highlights several of the more than 200 clinical trials that are currently recruiting patients at SCCA.

The Leading Edge Newsletter

Each quarterly Leading Edge newsletter will highlight a new topic to give you the latest news on leading-edge therapies that SCCA physicians are offering.