Cancer Translated’s top blog posts of the year

Developing exercise as “medicine” for cancer. Questioning guidelines for off-label use of cancer drugs. Using a common pain reliever to reduce breast cancer risks. These were some of the most engaging ideas explored by the Knight Cancer Institute’s ‘Cancer translated’ blog in 2018. We sorted a year’s worth of reader traffic to find the most popular reports. Here are the top 10:

10.

Halting resurgent prostate cancers before they spread: A new treatment option fills a void

Julie Graff, M.D.

When prostate cancer isn’t cured by surgery or radiation, the next line of defense is androgen deprivation therapy: lowering androgen hormone levels or stopping them from getting into prostate cancer cells. But these cancers inevitably develop resistance that enables them to progress, and at that point treatment options dwindle. OHSU and the VA Portland Health Care System enrolled more subjects than any other clinical trial site in the country in the practice-changing study establishing the benefit of apalutamide for this population of prostate cancer patients. Cancer Translated talked with OHSU Knight Cancer Institute oncologist Julie Graff, M.D., a co-author of the New England Journal of Medicine paper presenting the clinical trial results.

9.

A potential way to reduce the risk of post-partum breast cancers

Breast cancers that emerge in young women within a few years after pregnancy are strikingly more dangerous. A new study suggests that the common pain reliever ibuprofen might work as a preventive treatment to reduce the risk. The research also shows how ibuprofen or other non-steroidal anti-inflammatory drugs might make breast cancers more vulnerable to immunotherapy drugs that restore the ability of immune T cells to attack tumors.

8.

First evidence that PD-1 antibody could help men with metastatic prostate cancer

Restoring tumor-specific immunity is a treatment strategy that works well in melanoma and lung cancer patients. A new study is reviving hope that the approach also may help men with life-threatening prostate cancer. It is a surprising turnaround because prior results in men with aggressive, advanced-stage prostate cancer showed no evidence of anti-tumor activity with immune therapies that work by blocking PD-1 signals. Julie Graff, M.D., said the data provide, for the first time, evidence for meaningful clinical activity for PD-1 blockade in men with metastatic prostate cancer that is resistant to androgen deprivation. “It’s pretty remarkable, especially in light of the fact that many people doubted this approach could work at all,” said Graff.

7.

Cracking the code of advanced prostate cancer

For men in the U.S., prostate cancer is the second-leading cause of cancer death. Not all prostate cancers are the same, and researchers have learned much about the genetic changes and cell signaling modifications that make prostate tumors behave differently. Understanding the differences most important for cancer aggressiveness and treatment decision-making was the focus of a Marquam Hill Lecture by oncologist Joshi Alumkal, M.D.

Age-adjusted cancer death rates per 100,000 U.S. men, by tumor site (American Cancer Society)

6.

For military veterans with cancer, VA expands access to clinical trials in Oregon

The VA Portland Health Care System is one of 12 centers across the U.S. selected for a national initiative to give military veterans more opportunities to participate in cancer clinical trials. The chosen VA centers will gain direct and speedy access to clinical trials carried out through the National Cancer Institute’s National Clinical Trials Network and the NCI Community Oncology Research Program. The veterans’ hospitals will receive funding for three years to help cover the administrative costs of running trials and establishing a stable infrastructure for ongoing clinical research. “It is going to be transformational for this VA,” said Mark Garzotto, M.D., a staff urologist with the Portland VA and professor in the OHSU School of Medicine.

5.

Exercise as medicine for cancer: Q&A with Kerri Winters-Stone

Kerri Winters-Stone, Ph.D.

Exercise is not only safe during and after cancer treatment, studies have found that physical training can bring improvements in daily functioning and quality of life while reducing symptoms such as cancer-related fatigue. And there is even some early evidence linking exercise to living longer with cancer. The American College of Sports Medicine has convened a roundtable of experts who are working on a major revision of the group’s exercise recommendations for cancer survivors. Cancer Translated talked with roundtable participant Kerri Winters-Stone, Ph.D., about the prospects for using exercise to improve the care of people with cancer.

4.

Taking stock of the evidence for off-label use of cancer drugs

Doctors often expand the use of cancer drugs to situations beyond those explicitly approved by the Food and Drug Administration. And health plans will pay for those uses as long as they are supported by professional guidelines known as compendiums. But new research raises questions about the reliability of compendium recommendations. They sometimes endorse costly cancer drugs with serious toxicities for uses in which there appears to be limited evidence of effectiveness.

Breakdown of the evidence cited by a compendium for off-label use of cancer drugs (OHSU/Joe Rojas-Burke)

3.

Positive results with a targeted therapy for osteosarcoma, a cancer more common in young people

Osteosarcoma is a bone cancer that disproportionately affects teenagers, and outcomes for patients have changed little in decades. Now researchers, including two OHSU Knight Cancer Institute oncologists, are reporting improved progression-free survival for patients with advanced disease receiving the drug regorafenib, a tyrosine kinase inhibitor taken in pill form. “We’re really seeing a strong rational for moving regorafenib or similar drugs forward in the treatment of osteosarcoma,” said oncologist Lara Davis, M.D., an assistant professor in the OHSU School of Medicine.

2.

A new line of attack on deadly prostate cancers

Archana Sehrawat, Ph.D., and Joshi Alumkal, M.D.

For decades, drug development for prostate cancer has focused on blocking androgens, or male hormones, from activating a protein called the androgen receptor. Hormonal therapies, however, never work in some patients, and eventually all tumors develop resistance that enables them to progress. These lethal prostate tumors resistant to hormonal therapies are the second leading cause of cancer death in the U.S. Now, researchers at OHSU have uncovered a new target in lethal prostate cancer – lysine-specific demethylase 1, or LSD1 – that cancers use commonly as a workaround to resist hormonal therapies. The findings, published in the Proceedings of the National Academy of Sciences, set the stage for developing a new treatment approach to block lethal prostate cancer.

1.

How targeted exercise helps men with prostate cancer

Losing bone and muscle mass while gaining fat is a troubling problem for men receiving androgen deprivation therapy for prostate cancer, putting them at risk for heart disease, frailty and broken bones. Depletion of bone in these men is even more rapid than that associated with menopause in women. But a first-of-its-kind randomized clinical trial is providing evidence that targeted exercise can slow bone loss, reverse muscle weakness, and prevent gains in body fat in men with prostate cancer undergoing androgen deprivation therapy, or ADT.

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