Giant Steps Forward

Giant Steps Forward

There have been significant breakthroughs in cancer treatment over the last several years, and South Jersey physicians are proud to be part of the movement.

Nearly everyone has their own personal cancer story, whether they have suffered through it themselves or witnessed a friend or family member ravaged by it. While it may seem like a hopeless struggle at times, and one that will inevitably reach each person’s doorstep, the last decade has actually been very promising in the war against cancer. A number of scientific breakthroughs have come to the forefront, emerging from the hard work of the dedicated men and women who fight this deadly disease on a daily basis.
 
Some of those advancements have been developed and implemented right here in our region. South Jersey Magazine spoke to several local medical professionals to learn more about the progress being made in detection and treatment, which is allowing many patients to live longer or even be cured.
 
The importance of clinical trials
Regional Cancer Care Associates (RCCA) is known for forming personal relationships with patients while providing cutting-edge treatment options. A major way in which the practice achieves that goal is by conducting a wide variety of clinical trials, which are critical in ensuring that the latest methods and medications are available. Patients are able to participate in important studies that may drastically improve their quality of life.
 
“Clinical trials are essential for the development of new drugs and treatments for cancer,” says Dr. James Lee, an oncologist at RCCA Moorestown. “All drugs must be tested in controlled clinical trials before the FDA will allow their use in the general patient population. During clinical trials, the best way to give these drugs, reduce side effects and optimize efficacy are determined.
 
“Patients who participate in clinical trials may benefit from getting earlier access to new drugs before they are generally available, and get these treatments under closely supervised conditions. … Sometimes the new treatments may be offered at no charge, or [may] be better covered by insurance as part of a clinical trial. And of course, these patients can take pride in the knowledge that they may help future patients who suffer from the same cancer.”
 
Clinical trials have led to many positive developments in recent years, Lee adds, particularly with the development of targeted drugs that have changed the face of cancer treatment.
 
“One example is imatinib and other similar drugs that have led to cures of chronic myelogenous leukemia (CML) with just one pill a day,” he says. “Another class of drugs that has been a true breakthrough made possible by clinical trials is the checkpoint inhibitor immunotherapies, like nivolumab and pembrolizumab. These drugs work by stimulating our own immune system to fight the cancer and have led to dramatic responses and even cures in advanced cancers that were previously incurable and often untreatable, yet with minimal side effects.”
 
He cites the example of former President Jimmy Carter, who in 2015 was battling melanoma that had spread to his liver and brain. Just a few years earlier, his cancer would have been a death sentence, but it was cured after one year of nivolumab therapy.
 
A new approach to cancer treatment
Targeted therapies and precision medicine are the foundation of the state-of-the-art Cancer Center at Inspira Medical Center Mullica Hill, which opened in early 2020 as part of a sprawling new campus. Dr. Erev Tubb, medical director of cancer services, has seen the philosophy behind cancer treatment shift from focusing on a common treatment plan for as many people as possible to a personalized approach.
 
“Before we had targeted therapies, all we had were a certain number of chemotherapies, radiation and surgery and we were trying to find the best treatment for the most [patients],” he says. “Now we’ve developed a lot of targeted therapies—some that are targeted to mutations in the cancer, some that are targeted to mutations in the patient’s own genomes and some that are targeted to features of the cancer but not necessarily mutations.”
 
There are many different ways to target cancer, Tubb says, including medications that target receptors on the surface of the cancer cells, causing them to self-destruct or marking them so they can be destroyed by the immune system. Another example is small-molecule targeted therapy, in which medication is ingested as a pill and attacks specific features inside the cell itself.
 
In order to determine the best method of personalized treatment, Inspira oncologists do a family tree and genetic evaluation with each patient, as well as thorough testing of the tumor. “I explain it to my patients like this: I have all these keys and I know they all work in certain locks. I just don’t know which lock you have or don’t have,” Tubb says. “So even if I know this key belongs to a different type of disease, it may have a role in your disease. After all, these cancers don’t read our text books and they can mutate in ways we don’t expect. It’s certainly a minority of cancers that share features, but if you can find one and you can personalize treatment, avoid chemotherapy altogether or give patients a second or third track at treating their disease, then it’s worth doing. We do that not only on solid tumors but also so-called liquid tumors like leukemia and lymphoma.”
 
An important link that research has discovered is the role of the BRCA1 gene in several cancers. “The people with the BRCA gene are prone to breast cancers and ovarian cancers, which we’ve known for a long time, and we’ve also now identified that prostate cancer and pancreatic cancer may be in that same lineage,” Tubb says. “[This information] helps to let that patient and also their family know what their risks are individually and as a group. It also helps to choose certain medicines that are appropriate in these four disparate cancers.”
 
Tubb adds that targeted therapies generally have fewer side effects than chemotherapy and do not have a delayed propensity to cause a second cancer down the line.
 
Another important step Inspira has taken in recent months is a self-assessment tool on its website to help identify those who are at an elevated risk for hereditary illness such as breast, prostate or pancreatic cancers. The platform involves a user-friendly questionnaire that can be filled out online, and if the results raise any red flags, the patient is encouraged to meet with a nurse practitioner trained in genetics to develop a personalized plan for detection and prevention.
 
Breast cancer advancements
Awareness and technology have played key roles in reducing the death rate significantly in breast cancer through early detection. Yearly screenings are now recommended for women beginning at age 40, and 3D mammography allows radiologists to see through layers of tissue.
 
“This helps us find cancers that would otherwise be obscured by surrounding tissues,” says Dr. Catherine Piccoli, co-director of women’s imaging at South Jersey Radiology. “Tomography has increased the cancer detection rate and decreased the number of false positives as well.”
 
Because breast cancer is now being detected earlier, before it can be felt, it must be marked in order for a surgeon to successfully remove it during a lumpectomy. Until recently, the standard method to do so was with a wire inserted into the breast by the radiology department during the day of surgery. Not only did this prolong the patient’s ordeal and make it more stressful, it also caused great discomfort and affected a woman’s cosmetic outcomes.
 
Virtua Health has addressed these issues by adopting the latest technological advances in the field. A revolutionary system known as the LOCalizer uses miniature radiofrequency identification tags to mark the site of the cancer, allowing surgeons to remove even the smallest lesions. The procedure can be done up to 30 days before the surgery.
 
“It is placed in the area where the lump is, and in the operating room we can use this little machine that we wave over the breast. It emits a sound when we’re right on top of [the mass] and it even gives us the depth at which the mass is localized,” says Dr. Elizabeth Revesz, a breast surgeon at Virtua. “Therefore it’s a lot easier and more convenient for everybody, especially the patient.” Revesz adds that patients who have undergone both the wire and LOCalizer procedures report that “it’s night and day between the two technologies.”
 
The identification tags are the size of a grain of rice, Revesz says, and they are placed through a small needle, allowing surgeons to make incisions where scars will be hidden. “Afterwards we do oncoplastic closure for these patients, where we rearrange the tissue so cosmetically it looks like it’s never been touched,” she explains. “We have very good outcomes and the [LOCalizer] definitely helps. Because we find the cancer earlier, we treat it better and the patients live a longer, healthier life afterwards, I think it’s really nice not to have a big scar and a deformed breast to remind them of the ordeal they went through.”
 
Another tool Virtua is utilizing is called the MarginProbe. In the past, the margin of tissue surrounding the mass was tested after surgery with ultrasound and mammography, and if abnormal cells were found, a second operation would be necessary. With the hand-held MarginProbe, the margins can be checked immediately following the initial lumpectomy, allowing the surgeon to remove more of the tissue right then, if necessary, and reduce the chances of the breast cancer reoccurring.
 
Revesz is thrilled to see Virtua welcoming advancements like LOCalizer and MarginProbe and is excited to see what the future holds in breast cancer treatment.

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“You can see it in the outcomes these patients have because the treatment for an early breast cancer is so much less taxing on the patient and has such a good outcome in the end,” she says. “We’re making great progress and I’m sure there’s more to come. I don’t want to venture a guess as to what’s coming next, but we are open and ready to embrace whatever will help our patients.”

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Published and copyrighted in South Jersey Magazine, Volume 17, Issue 12 (March 2021).

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Author: Matt Cosentino

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