It has been 40 years since President Richard Nixon in effect declared war on cancer by signing the National Cancer Act and infusing $100 million more into research aimed at eradicating America's number-two killer.  He said then, "The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease. Let us make a total national commitment to achieve this goal."

Over the last four decades, researchers have spent billions of dollars and have blazed new trails that make clearer the path to understanding cancer and its origins.  Yet the ultimate goal of conquering the disease remains elusive.  Our guests this week include Dr. Ronald Hempling,director of oncology services at WellSpan Health in York, and Dr. Kathryn Peroutka, a hematologist and oncologist with PinnacleHealth.  Dr. Gavin Robertson, director of The Melanoma Center at Penn State Milton S. Hershey Medical Center, will share with us an exciting new advance in the treatment of skin cancer that was developed in their labs.

"There's a lot of very exciting information and exciting news about cancer research," Dr. Peroutka enthused over the phone. "And the thrust now is very much -- not that we find therapies by accident or because it worked well in some other form like an antibiotic -- but that we actually figure out why the cancer is doing what it's doing, why is it growing abnormally, and then very purposefully making a drug that works at that step or at that level.  That concept is called targeted therapy.  So that is where a lot of new research is headed."

She notes that the researcher-patient connection is critical.  "The other concept that is important is the idea that there is a researcher in the lab working on something but we want to get it to the patient at home or the patient in the clinic.  And so that concept of taking that research from the lab to the patient is called translational research.  We're trying to get things that make sense and then have a benefit right away," she says.

Another promising new development is a deeper level of pathology analysis.  "There are so many new kinds of understandings of pathology reports.  We do pathology reports and we used to say, 'This is breast cancer.'  Now we say, 'This is breast cancer with this characteristic or that characteristic.'  And that understanding helps us figure out the best way to start treatment for that particular patient.  We have been doing that with breast cancer for awhile, but we're doing that more recently with colon cancer and even more recently with lung cancer."

Perhaps most promising of all are the new drugs, targeted therapies coming out of the labs around the country.  "It's a very well understood two-way street," Dr. Peroutka explains. "What's going on in the research lab is being reported to those of us in the clinic.  And then clinical findings are going right back to the researchers.  Most of that is happening at the major cancer-research hospitals.  There is a system called the NCCN (National Comprehensive Cancer Network.)  The biggest 10-12 cancer hospitals in the country formed this consortium and the NCCN puts out guidelines and updates them every year for every cancer, so that essentially, any doctor anywhere knows what the appropriate first treatment should be for this kind of cancer or that kind of cancer. "

This disease is very personal to Dr. Peroutka.  In 1994, she was diagnosed with breast cancer and has been cancer-free now for 15 years.   "I don't talk about my own cancer very much because I don't want people to think, 'Oh, well that's how she did it so that's the way it should be done. Or, that's the way it affected her.'  But what I do think is that it's a good message that nobody, nobody is really free from the risk of cancer," she emphasizes. "I was taking care of patients all day long the day I went for my mammogram at the end of the day, and even though I take care of patients with cancer, I got it too.  There is nobody who is not going to be touched by it."

Dr. Hempling writes in an email that he would be cautious about my use of the word "breakthrough." He writes that he is, " ... more comfortable with the word "advances."  These occur in 2 primary arenas:  in the laboratory and at the bedside.  In the laboratory, major advances have included the molecular genetics and biology of the cancer cell and its implication for finding a place in that biology which can teach us something new about the way in which the cell functions or can be used to guide new therapy.  For example, within the recent past the activity of the K ras oncogene in cell replication in malignant tumors.  Over expression (activity) of the gene has been found in some tumors while absent in others.  This reinforces the long-held belief and now provable theory that cancer is a heterogeneous group of diseases and not a monolithic entity.  Indeed, it is safe to say that no two cancers, even when they arise from the same organ, are alike. K-ras has proved to be a marker for responsiveness to certain designer chemotherapy drugs in patients with recurrent colon cancer, while not predictive in the same manner in patients who suffer from lung cancer."

Dr. Hempling says these advances have led to the next phase of treatment.  "This takes us to step two -- wherein the findings at the bench are brought to the bedside.  Let's stick with K ras for a moment.  So we have found that the gene is over expressed in some tumors and not in others.  What does that mean?  Is it predictive of something or prognostic of outcome?  Can we design a test (trial) to examine this hypothesis?  Well, as it turns out, again demonstrating that cancer is not one disease but is many diseases and even heterogeneous within diagnoses, clinical trials have demonstrated that among lung cancer patients this finding is neither predictive nor prognostic, but among patients who are suffering from recurrent/metastatic colon cancer it is both predictive and prognostic.  Patients who have recurrent/metastatic colon cancer who demonstrate a mutation in this gene have a worse prognosis than those who do not and will not respond to some of the newer chemotherapeutic drugs ie EGFR (Epidermal Growth Factor Receptor) Inhibitors."

"At our facility we recently completed a study of patients treated with balloon brachytherapy among patients diagnosed with breast cancer and compared the results to patients treated with conventional whole-breast radiation," he explains.  "The brachytherapy device (called Mammosite) was approved by the FDA after it was tested for safety on 30 women...safety mind you ... not effectiveness.  Its primary advantage is that rather than six weeks of external beam therapy for patients treated with breast cancer, therapy can be completed in five days.  While theoretically it should be as good, nobody had proved it.  Our study demonstrated that there was no statistically significant difference in local recurrence rates between selected patients treated with this device and those treated with conventional therapy.  There is no other study like this.  So, the community is fertile ground not just for enrolling patients in large multi-institutional trials sponsored by trialist organizations coming from the NCI (National Cancer Institute,) but for original research as well."

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