On October 1, the American Cancer Society (ACS) Cancer ActionNetwork (CAN) along with presenting sponsors University of Colorado CancerCenter and UCHealth hosted more than a hundred leaders from business,education, government, and research communities to answer an interesting question:What do a highly successful new treatment against leukemia stem cells, a newway to point the immune system at pediatric cancer cells, and new understandingof how Medicare expansion affects cancer outcomes have in common? The answer:All three are born in Colorado. Due in part to new investments in infrastructureand the recruitment of top talent, combined with a climate of collaboration andinnovation, CU Cancer Center researchers are at the forefront of discoveries andinitiatives that are driving a golden age of cancer prevention, research, andcare.
Delivering quick welcome messages were representatives from the offices of Senator Michael Bennet, Senator Cory Gardner, and Representative Jason Crow, along with RJ Ours, Colorado Government Relations Director for ACS CAN. Attendees included John J. Reily, Jr., MD, Dean of the University of Colorado School of Medicine, and Don Elliman, Chancellor of the University of Colorado Anschutz Medical Campus.
Wereworking today to strengthen Colorados network of people collaborating to fightcancer so that you have the new tools and resources to accelerate the pace of discoveryduring this significant period of change, opportunity, and promise to endcancer as a health problem, Ours said, setting the tone.
Leading the mornings program was CU Cancer Center Director,Richard Schulick, MD, who spoke about the burden of cancer, the strategies weuse to attack it, and the activities across the CU Cancer Center consortium todevelop new strategies for cancer prevention, early detection, treatment,education, and access to care.
Im here not only as the cancer center director, but as the sonof two parents who developed cancer during their lifetimes. My passion comesfrom very personal experience, Schulick said. What is our goal? For the peoplein this room, the goal is to eradicate the pain and suffering from cancer.
Despite a 26 percent reduction in the death rate of peoplediagnosed with cancer over the previous 25 years, there remains a long way togo toward Schulicks goal. In the next decade, cancer is set to overtake heartdisease as the leading cause of death in the United States. About 1.7 million Americanswill be diagnosed with dangerous cancer this year, and 600,000 will pass fromthe disease, over 8,000 in Colorado alone. Lifetime cancer risk is about 40percent and the risk of dying from cancer is about 20 percent.
I cant imagine a more pressing problem we need to deal with a society,a research institution, and as a community, Schulick said.
In addition to innovative, new treatments, Schulick says manygains will come from learning to better use existing treatments. For example, thetraditional workflow of cancer care starts with a primary care physician, whorefers a patient to an oncology specialist, who may send the patient a weeklater for diagnostic imaging, then a week later to consult with a surgeon, who sendsthe patient to a radiologist, etc. all of which results in many appointmentsover the course of weeks or months just to decide on a course of care. Instead,at CU Cancer Center care partners, patients may be seen in multidisciplinaryclinics.
Its a better model for taking care of cancer patients, Schulicksays. They come in the morning, get a physical exam and any needed imaging, seea nutritionist, a pain specialist, etc. Thenall the doctors and specialists meet from noon to one and go over everything,typically with 30 or more people in the room. Everyone is there, they all weighin and argue about the best treatment plan. Then the whole team meets with thepatient, all at the same time. In one day, everything is done, the whole treatmentplan laid out. Patients love this and their families love it even more.
Now a major goal is to expand access to the best cancer care topatients outside the Denver metro area.
Were trying to make the very best care available to every citizenin Colorado and surrounding states, no matter where they live. Its no good ifwe have all the best therapies and clinical trials concentrated only on thiscampus that doesnt do any good for a lot of people who cant get here. So wehave to spread our ability to care for these patients, Schulick says.
The second presentation highlighted this need for additional services to reach Colorados rural and underserved populations.
Cathy Bradley, PhD, CU Cancer Center deputy director, pointed out that the lung cancer survival rate for patients living in the Front Range is 70 percent, while the survival rate for Coloradans living in rural and high-poverty areas is only 55 percent. Likewise, rates of HPV vaccination that can effectively prevent cervical cancer are 45 percent in Colorado as a whole, but only 28 percent in rural areas.
These disparities are wider than they are elsewhere, Bradleysays. Our white population does better than whites nationally, while our Hispanicsdo worse than Hispanics nationally. And the Colorado youth vaping rate is fourtimes the national average.
Bradley also pointed out the benefit in focusing on cancerprevention, pointing out that while $500,000 could help 3,000 people becomenon-smokers, or screen 700 people for lung cancer, or screen 1,200 people forcolon cancer, the same amount of money is only enough to treat 4-8 people withadvanced cancers.
Until recently, one of the worst of these advanced cancer wasacute myeloid leukemia (AML).
AML is an absolute monster of a disease, one of the mostaggressive forms of cancer known to man. Until a couple years ago, they neverwould have invited someone like me to a breakfast like this: I would have beentoo depressing. Thats all changed in the last couple years, says Daniel A. Pollyea, MD, MS, the Robert H. AllenEndowed Chair in Hematology Research and clinical director of Leukemia Servicesat the CU School of Medicine.
Based on CU Cancer Center basic science, Pollyea and colleagueshave built a hematology program specifically focused on targeting leukemia stemcells.
Its population of cells that cant be killed with chemo and thatcauses relapse, Pollyea says. We believed that if we could kill leukemia stemcells, maybe we could even cure the disease.
The treatment that Pollyea was able to offer to Colorado patientsthrough clinical trials in 2015 earned FDA approval in 2018.
Patients here were essentially getting a treatment of the future,kind of time traveling years into the future to get a therapy that wasntavailable then. Thats what so incredible about being a clinician who works inresearch the hope we could deliver a treatment of the future to a patient today,Pollyea says.
Now new trials at CU Cancer Center are refining Pollyeas treatmentand showing that targeting cancer stem cells may have applications for morepeople with AML and perhaps even beyond leukemia.
At other places, it can be like, Weve never done this before sowere not going to do it now. Here at CU, its more like, Weve never donethat before so lets figure out how to make it happen, Pollyea says.
One of these new things we are just figuring out is how to makehappen is engineering a patients own T cells to attack cancer, which is thespecialty of the mornings third speaker, Terry Fry, MD, CU Cancer Centerinvestigator and co-director of the Human Immunology and ImmunotherapyInitiative at Childrens Hospital Colorado.
I was happy with my career at the National Institutes of Health,Fry says. I had developed a good team, and when Lia Gore [of CU Cancer Centerand Childrens Hospital Colorado] called me to take a look, it was sort of a, Oh,okay, Ill take a look. But from my first visit, it was pretty clear that Coloradowas the place I wanted to be to develop the next generation of immunotherapy.
The first generation of immunotherapies was developed more than acentury ago, when a doctor named William Coley noticed that some cancerpatients who developed infections actually had better cancer outcomes in rarecases, an activated immune system would attack tumor tissue. Then radiation andchemotherapy showed more promise, and anti-cancer immunotherapy went on theback burner for many decades. Terry Fry is a pioneer in the generation ofscientists who revived the idea, often despite naysaying by many in theresearch community who thought it would never pan out.
I just heard Jimmy Carter is celebrating his 95thbirthday today. He was one of the first recipients of immunotherapy for braincancer, Fry says.
But while Jimmy Carters treatment was meant to remove a kind ofbraking system that kept the immune system from attacking cancer, Fryspecializes in the design and testing of treatments that engineer the bodysimmune system T cells to recognize and attack cancer cells.
Ive been privileged to be part of a field called geneticallymodified T cell therapy, or CAR-T cell therapy. Fifteen or twenty years ago, nobodywould have ever thought that it would be possible to take T cells frompatients, genetically modify them to see proteins on the surface of cancer cells,and then reinfuse them as a drug to target cancer, he says.
Still, major challenges remain for CAR-T therapy. Despite beingable to induce remission in 80 percent of pediatric patients with B-cellleukemia, about 50 percent will relapse within the first year.
I certainly dont feel like were done, Fry says. This is atherapy that is very, very new for us in the field of cancer treatment, and westill need to improve induction rate, durability, and the ability to deliver thetreatment safely.
Another challenge for CAR-T therapy is cost, an issue brought upby the first question delivered to the panel by a parent whose daughter hadbeen treated at UCHealth University of Colorado Hospital.
For a long time, the whole conversation was about therapy success,and now people are starting to talk about the challenge of access, Fry says. Thecost of CAR-T is about three or four-hundred thousand per treatment, so its areal challenge that we need to figure out. One thing being discussed is thatthe standard treatment is chemo and bone marrow transplant, which costs morethan $500K and we pay for that now. If we can do this therapy the right way,theres a possibility it could replace another expensive therapy. Also, a lotof work is being done to bring down the cost of these treatments.
The next question asked about research into the rising rate ofcolorectal cancer diagnosed in adults below age 50.
Right now, in my inbox is data describing Colorado rates ofcolorectal cancer in people under 50, says Cathy Bradley. Its something wereaware of as a problem and is just starting to get attention nationally.
Schulick pointed out that the American Cancer Society is leading apush to lower the recommended age to start colorectal cancer screening from 50to 45. The question is whats the cost and what are the lives saved, Schulicksays, but I think theres enough evidence now to lower the screening age.Another frontier is genetic risk. The idea is that maybe if you have a certainpanel of genes, you have your first colonoscopy at age 20 or 30 or 40. I thinkthe frontiers are being pushed and were learning more about genetics and riskfactors and how to implement screening that saves lives.
Additional questions focused on how federal policies may affectcancer research, including a proposal to increase annual NIH funding by $6 billion,and how Medicare expansion has affected cancer outcomes.
In a study funded by the ACS, we looked at states that expanded Medicareand those that did not, and found that with far more low income women beingscreened, there were fewer late-stage diagnoses, and longer survival, saysBradley. Also, the availability of medications through Medicaid meant that morewere people taking medicines as directed, and more people staying in theworkforce.
These federal policies that affect cancer research and care mayseem abstract, but the ACS closed the morning by offering two ways to getinvolved now: First, ACS Ambassador Martha Cox suggested signing the ACSpetition to increase cancer research funding; second, Cox suggested becominga member of the ACS Cancer Action Network.
Despite significant progress against cancer, there remains muchmore to do. Right now, here in Colorado, we are at an absolute epicenter of researchaimed at the disease. Events like this mornings ACS research breakfast ensurethat everyone in the community of people who care about cancer is aware of thegreat opportunity and also the great responsibility we have to continuepowering this push toward a day when suffering from cancer is no more.
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