Treatment on target: Research, technology offers personalized cancer treatment

Medford Transcript

Oct. 3, 2013

By Nicholas lovino & Sue Scheible

As cutting edge research steers doctors toward a more individualized approach to cancer treatment, one local health care provider has added a new tool in its arsenal to better target and kill cancer cells in the body.

Last April, Hallmark Health started treating patients with Elekta Infinity, a new radiation treatment system that reduces the time patients must undergo radiotherapy, thanks to a more sophisticated targeting mechanism.

"The biggest advance with this is better imaging capability to allow us to be more accurate, and it delivers the radiation faster so their overall time is reduced," said Glenn Davis, manager of oncology services for Hallmark Health System, which operates Lawrence Memorial Hospital of Medford and Melrose-Wakefield Hospital, among other local facilities.

Davis said enhanced targeting allows doctors to reduce side eiTects that often accompany radiation therapy as well, such as fatigue and skin irritation.

That improved targeting is made possible by an agility head with ISO leaves that alter position based on where the cancer cells are physically located in each patient.

"We installed a brand new lGO-slice oncology specific CAT scan in our department," said Davis. "That allows us to do better 3-D imaging of the breast to better target the area of concern and avoid the normal, healthy surrounding tissues to prevent side effects."

Davis said about half the patients treated at Hallmark Health's CHEM Center for Radiation Oncology on Montvale Avenue in Stoneham suffer from breast cancer.

A team of doctors at Hallmark Health's Comprehensive Breast Center examines a wide array of factors to determine the best combination of treatment for each patient. Treatments vary from surgery to radiation therapy to chemotherapy, a treatment in which medication given to the patient targets cancer cells. A combination of various treatments is often recommended.

"It's very case-specific," said Davis. "It's a high percentage of breast cancer diagnosed patients that receive radiation treatment.

He added the average cancer patient receives about 25 to 33 radiation therapy treatments over the course of six to seven weeks. Patients are exposed to the radiation beam for about 10 minutes, down from about 15 minutes before new technology made targeting more accurate.

Davis said the biggest advantage for his patients is attaining the same level of care with the latest technology without having to drive into Boston to seek treatment at large teaching hospitals.

The Hallmark Health CHEM Center has been caring for area patients for more than 20 years and was the first freestanding radiation oncology site in Massachusetts.

New research

Meanwhile, cutting-edge research in breast cancer is taking place in a rapidly expanding variety of fields, from molecular to medical to surgical oncology. It can be hard to get a handle on it all.

The result: women facing a diagnosis today face a much more personalized or individual approach with testing and treatment options tailored to their own biology, type and subtype of cancer, stage of growth and family history.

"With time, I am certain this new approach will positively affect survival rates, but already we are minimizing the need for chemotherapy following initial surgical treatment," said Dr. Katherina Zabicki Calvillo, associate director of the Breast Center, Dana-Farber/Brigham and Women's Cancer Center in clinical affiliation with South Shore Hospital in Weymouth.

The latest clinical trials are only a click on a web site away: clinicaltrials.gov is recommended by advocates and physicians as the best-centralized source, maintained by the National Institutes of Health. And the web sites of many community hospitals have links to clinical trials they are participating in.

"Physicians in the community have point people in the academic centers, and we go out to attend tumor boards at the community level," Cavillo said. "People can always come into Boston for second opinions and then go back out to their community for ongoing clinical work."

Dr. Eric P. Winer, director of the Breast Oncology Program at the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, also traced significant changes over the past 12 years.

"We no longer think of breast cancer as one disease, but as a family of four or five distinct types of diseases, each with a different personality," he said. "We can have a much more detailed understanding of the underlying biology. Our ability7 to apply that knowledge to the clinical trials we have underway has advanced incredibly."

Oncologists are also learning more about why the same types of cancer act so much more or less aggressively in different people.

A range of factors, Winer said, are thought to influence why one woman will deal better, from a biological standpoint, with a cancer and its response to treatment - why her disease does not recur or is not as aggressive if it does recur, after the initial treatment.

That has sparked renewed interest in the immune system.

"Some of this is very new," he said. "Something in our immune system has allowed us to create the cancer (the unregulated growth of cells) and something allows some people, with treatment, to enhance their ability to contain that cancer."

The new genetic code information is helping doctors target which types of cancer will respond to which chemotherapy.

"The problem with drugs that are thought to prevent cancer can be you end up having a lot of people taking a drug to prevent something that never does develop anyway," Winer said.

A steady source

A steady source of research funding for Massachusetts medical centers and other institutions has been Susan G. Komen for the Cure. Ronni Colien-Boyar, executive director of Komen MA and a breast cancer survivor, said that this year, $4.7 million in new funding will go to Dana-Farber Cancer Institute and Harvard Medical School to research on environmental factors that influence breast cancer development.

Other Komen research giants in Massachusetts are looking at gene mutations, treatments and preventing recurrence.

"The most exciting work going on now is the move towards personalized treatment - getting at the root cause of each individual tumor, what is causing it to occur, why some tumors are receptive and some resistant, to chemotherapy, who needs treatment, at what point, when we are over treating versus when we can get to the early stages," she said.

The Massachusetts Breast Cancer Coalition recently announced a new video series, MBCC Research Updates, designed to present the facts about environmental health and breast cancer prevention. Each short video features an interview with a researcher, medical professional, university professor, breast cancer activist, or other prominent figure in the field.

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