Cancer Research: Making Progress

By Debbe Geiger, Duke Medicine News Office
December 2009

Cancer is not going away. In fact, health experts predict a 15 percent increase in new cancer cases in North Carolina over the next five years. In the Triangle, that increase is predicted to top 20 percent.

Area hospitals are responding to those projections by expanding their services. At Duke University Medical Center, construction started last month on an extensive expansion of its Comprehensive Cancer Center. When it opens in 2012, all cancer outpatient treatment and clinical services will be available in one place. It follows the opening this Fall of another university-based cancer treatment center in the area.

“Cancer care and research are core areas of excellence within Duke Medicine, and many of our faculty have recognized national, and international, reputations for innovation in this field,” said William J. Fulkerson, Jr., MD, senior vice president for clinical affairs for Duke University Health System.

“Duke faculty are leading or participating in more than 700 cancer research studies, and the excellence of our basic science and clinical researchers will always be a critically important driver of the success of our Cancer Center,” said Nancy Andrews, MD, PhD, dean of the Duke University School of Medicine.

Here’s a brief look at some of the recent advances made by Duke researchers, and a glimpse at what’s on the horizon:

Lowering Prostate Cancer Risk with Exercise
A moderate amount of exercise most days of the week may contribute to a lower risk of prostate cancer, and lower grade tumors among those men who are diagnosed with the disease following biopsy, according to a study that appeared recently in the Journal of Urology. It adds more fuel to the ongoing debate over the benefit provided by exercise to men seeking to prevent prostate cancer.

“There have been dozens of studies about the value of exercise in lowering risk of prostate cancer, and some of them quite large, but they’ve left us with mixed signals,” says Stephen Freedland, MD, a urologist at Duke and the Durham VA and the senior author of the paper.

In this study, the investigators found that men who regularly engaged in moderate activity—anything equivalent to walking at a moderate pace for several hours per week—were significantly less likely to be diagnosed with prostate cancer. If they were diagnosed, they were less likely to have aggressive disease.

Most of the men in the study fell short of the American Heart Association’s guidelines for the minimal amount of exercise needed per week. Researchers found that a majority of the men (58 percent) were sedentary, meaning they exercised less than the equivalent of one hour per week of easy walking. Forty-six percent were moderately active; only 33 percent were very active.

The investigators found that any amount of exercise was associated with a trend toward a lower risk of prostate cancer.

New Way to Classify Stomach Cancers May Improve Survival
An international team of scientists has discovered a new way to classify stomach cancers, an advance that Duke researchers say may be an important step toward designing more effective treatments and improving long-term survival.

Stomach cancer represents the second leading cause of cancer deaths worldwide. They are notoriously resistant to chemotherapy, and newer biologic-based therapies have not proven very effective. With current treatments, less than one quarter of patients live longer than five years after surgery.

The new system classifies stomach cancers by the signaling pathways the tumors use to grow and spread, rather than the more traditional approach that describes them by cell type or structure. This difference, the researchers say, may offer physicians the opportunity to group patients according to their tumors’ pathway profiles and then apply the treatment that is designed to interrupt the signals those pathways use.

“These findings may give us the first way to truly offer our gastric cancer patients personalized medicine,” says Patrick Tan, MD, PhD, senior author of the study, which appeared online in the Public Library of Science journal PLoS Genetics. Tan is a member of the Duke-NSUS Graduate Medical School and the Genome Institute of Singapore.

An Experimental Vaccine for Brain Cancer
An experimental vaccine is now being tested for the treatment of glioblastoma, the most common brain cancer in adults.

Glioblastoma is an aggressive form of brain cancer that strikes more than 10,000 Americans each year. Only half of patients survive for one year, even if they’ve undergone radiation and surgery to remove as much of the tumor as possible.

Unlike traditional vaccines, which are designed to pounce on bacteria or viruses when they strike, this experimental therapy activates the immune system to launch an assault on an existing tumor.

The vaccine, which was developed by John Sampson, MD, a neuro-oncologist and brain surgeon at Duke’s Preston Tisch Brain Tumor Center, treats a specific type of glioblastoma that is found in up to 40 percent of cases. It targets only the tumor cells and nothing else.So far, the results have been promising.

Why Some Cancer Treatments Cause High Blood Pressure
Cancer patients are living longer as the result of drugs that block the formation of new blood vessels which feed tumor growth are helping some. But the good news has a dark lining: up to one third of patients who take these anti-angiogenesis drugs develop high blood pressure. Duke scientists may have figured out why.

“Anti-angiogenesis drugs like Avastin, Sutent, or Nexavar inhibit an important substance that stimulates the creation of new vessels that support malignant growth,” says Thomas Coffman, MD, a professor of medicine, cell biology and immunology at Duke and the senior author of the study that appeared online in the journal Hypertension. “Our studies in mice show that blocking this substance causes hypertension because it disrupts an important biological system.”

The researchers found that amount of medicine given made a big difference. A modest amount of the drug didn’t cause a jump in blood pressure, but a high dose equivalent to the therapeutic amount a cancer patient would receive, caused blood pressure to rise. “The higher doses of anti-angiogenesis drugs that patients need to keep their cancers from growing translate into a significant increase in risk for hypertension and, by extension, for cardiovascular complications,” says Coffman.

As cancer patients live longer, side effects like hypertension, which might once have seemed less important, take on new meaning. “Long-term hypertension can have serious consequences,” Coffman says.

Herbert Hurwitz, MD, a medical oncologist at Duke and one of the first to document how Avastin and other anti-angiogenesis drugs provide benefit to cancer patients, says anti-angiogenesis drugs are helpful to most patients, and any resulting hypertension is usually manageable with traditional blood pressure medications.

“However, these new findings are important since they point to specific ways to better protect against the risks of long-term hypertension. They also suggest ways to protect patients against other serious but uncommon side effects, like stroke or heart attack.”

Helping Breast Cancer Patients Cope
Pathfinders, a program designed to care for the whole person—body, mind and spirit—has been found to help women with terminal cancer cope and improve their quality of life, according to a study led by researchers in the Duke Comprehensive Cancer Center.

“The program helped improve distress and despair during the initial three months and up to six months after diagnosis among women with metastatic breast cancer and a six month life expectancy,” said Amy Abernethy, MD, a Duke oncologist and the study’s lead investigator. “Even though the women were getting sicker and experiencing more symptoms related to their cancer, they reported that they felt less distress and despair as a result of being able to better cope with the cancer.”

Pathfinders focuses on the seven pillars of personal recovery: hope, balance, inner strengths, self care, support, spirit, and life review. The program provides patient navigation, counseling, coping skills training, mind and body techniques, and lifestyle advice.

“The goal of the program is to teach patients coping skills for dealing with their cancer,” said Tina Staley, director of Pathfinders. “To reach this goal, we have created a common language between patients, nurses, physicians, and Pathfinders for communicating coping skills.”

“There is a growing body of data that shows cancer patients have unmet psychosocial needs, and with programs like Pathfinders we are able to care for the whole person,” Abernethy said. “As a result, we found that this group of women reported a higher quality of life three months after being diagnosed than was expected.”

On the Horizon: Exploring the Link between Cancer and the Environment
The Duke Comprehensive Cancer Center has teamed with the Duke Nicholas School of the Environment and Earth Sciences to investigate the role the environment plays in cancer. The goal is to unravel the interplay between genes and the environment in order to better understand why some people develop disease and why some remain unaffected when exposed to the same environmental factors. By doing so, researchers how to gain a better understanding of how genes and environmental agents interact to affect the whole organism. Ultimately, the researchers hope to identify new targets for potential drugs and help identify susceptible individuals who might be at higher risk for cancer.

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