Patient Care: Major Highlights
Annual Report - 2005-2006
Caring for the Children
Described as a place “where kids rule, not cancer,” the Children’s Cancer Hospital at M. D. Anderson is much like the basketballs that often bounce around in the PediDome — it keeps going higher and, more often than not, makes the goal.
With a more than 50-year history of outstanding patient care as a foundation, the Children’s Cancer Hospital has built on this solid base with a new name and logo and an enhanced team of physicians on staff to treat pediatric patients.
Childhood cancer is a rare disease, but because pediatric patients are treated under the larger umbrella of a comprehensive cancer center, translational protocols from adult treatments have an easier journey into the children’s side of cancer. Likewise, adults benefit from clinical trials tested in children. Because of the close partnership between the pediatric and adult services at M. D. Anderson, a successful leukemia protocol for high-risk pediatric patients is now being evaluated in adults.
Children benefit from unique protocols offered at M. D. Anderson, in addition to those that are sponsored by the national Children’s Oncology Group.
Several protocols evaluating new therapies for osteosarcoma (bone cancer), for instance, are ongoing. With the promise of fewer side effects, aerosolized chemotherapy is being tested for treatment of osteosarcoma that has spread, or metastasized, to the lung.
Physicians also are studying whether gene therapy increases immune responses to fight lung metastases, and if oral drugs used to target growth-promoting proteins in adult cancers can be used to treat pediatric osteosarcoma.
Brain tumors are a target as well, with a Phase III combination trial comparing two treatment protocols for gliomas under way and a gene therapy approach for medulloblastoma under development.
Discoveries made in the laboratory also are helping to direct treatment. Identification of absolute lymphocyte count as a determinant of risk and survival for pediatric patients with leukemia, non-Hodgkin’s lymphoma and Ewing’s sarcoma is a meaningful example. Based on this finding, an easy and affordable test now establishes whether a young patient should receive standard therapy or a more aggressive treatment.
This sound, forward-thinking approach mixes well with the top-drawer care a young cancer patient receives at the Children’s Cancer Hospital. Add a dash of hope for good measure, and the winning goal of higher survival rates for pediatric cancer patients is a slam dunk.
Setting New Standards of Care
Clinical research has been a driving force for change in how cancer is managed today, and M. D. Anderson investigators are leading the charge.
With its large patient base and outstanding research programs, M. D. Anderson is positioned to conduct all phases of a clinical trial and bring forth findings of promising new agents to be considered by the U.S. Food and Drug Administration, says Maurie Markman, M.D., vice president for clinical research.
Three such drugs tested in M. D. Anderson-led multi-center trials have been approved by the FDA this past year.
Taxotere, a common breast cancer drug, was approved for use in combination with chemo-
therapy to treat patients with advanced stomach cancer.
The FDA based its decision on results from the TAX 325 study, the largest international Phase III clinical trial in previously untreated advanced stomach cancer, says Jaffer Ajani, M.D., study principal investigator and professor in the Department of Gastrointestinal Medical Oncology.
Cetuximab, a monoclonal antibody previously approved to treat advanced colorectal cancer, gained FDA approval for use in treating head and neck cancer.
"For patients with locally or regionally advanced disease, cetuximab in combination with radiation therapy has demonstrated a clinically significant improvement in survival and locoregional control,” says radiation oncology professor Kie-Kian Ang, M.D., Ph.D., who coordinated the pivotal international trial.
Decitabine, called a major advance in the ongoing fight against myelodysplastic syndrome, or MDS, was approved as “a new treatment option pioneered at M. D. Anderson that can reduce or eliminate the need for frequent blood transfusions among patients with MDS,” says Hagop Kantarjian, M.D., study lead and chair of the Department of Leukemia.
Results from a multi-center Phase III clinical trial demonstrated an overall response rate of 21 percent in MDS patients treated with decitabine. None of the responders required transfusions during this time, adds Kantarjian, clinical investigator for the decitabine clinical development program for MDS and acute myelogenous leukemia.
“A great thing about M. D. Anderson is that our clinical investigators never stop,” Markman says. “When a new standard is set, they move to find something better, which may mean it’s more effective or as effective, but less toxic.”
Drug Combo Increases Melanoma Survival
If caught early, melanoma often can be treated successfully by removing the lesion, along with a portion of the surrounding tissue.
The problem arises when melanoma spreads, or metastasizes, beyond its original site. Once the disease has migrated beyond the local lymph nodes, it’s difficult to treat and survival is low.
By design, the pigment-producing cells in the skin are hardy with an elaborate DNA repair mechanism in place to protect the skin from ultraviolet light. This very resiliency increases melanoma cells’ ability to resist the effects of chemotherapy, making standard cancer treatments less than optimal.
Although current therapies work in some patients, they have had a limited ability to fight metastatic melanoma in the majority of patients until now.
Results of a Phase II study “are encouraging and point to a potentially more effective and less toxic therapy for treating metastatic disease,” says Wen-Jen Hwu, M.D., Ph.D., study lead investigator and professor in M. D. Anderson’s Department of Melanoma Medical Oncology.
Hwu and her colleagues reported in the journal Cancer that temozolomide plus pegylated (long-acting) interferon-alpha-2ß had significant antitumor activity in patients with stage IV metastatic melanoma.
Separately, temozolomide and interferon-alpha-2ß are active in melanoma, Hwu notes, but together — and with the right dose and treatment schedule — they become a force to be reckoned with. “At lower doses and for a longer period of time, we found that constant levels of both drugs can be maintained and provide a more sustained benefit,” Hwu says.
Patients received low-dose temozolomide daily for six weeks, with a two-week break between cycles, and a weekly injection of very low-dose pegylated interferon. More than one-half of patients had either objective clinical responses or stable disease, Hwu says. With surgery, those with partial or mixed responses were rendered free of clinically detectable disease.
“While it’s good to have improved responses,” Hwu says, “the most important question is, ‘Did our patients live longer?’”
The answer is “yes,” she says. “Patients with late-stage melanoma typically live six to nine months. With this combination therapy, more than one-half of the patients on this study survived one year or more, so we’re making progress.”
Shelter From the Storm
No one will forget the scenes of devastation as Hurricane Katrina cut a swath through Louisiana, Mississippi and Alabama in August 2005.
Houston escaped the destruction caused by the hurricane and its aftermath. But with typical compassion and skill, M. D. Anderson employees sprang into action to assist Gulf Coast neighbors fleeing the storm’s wrath.
Many M. D. Anderson physicians, nurses, pharmacists and other caregivers spent their free time providing medical help to hurricane evacuees at Houston’s Reliant Astrodome and George R. Brown Convention Center. Other staff members sorted and distributed clothing at shelters and opened their homes to evacuees.
“I was proud of our employees,” says Thomas W. Burke, M.D., executive vice president and physician-in-chief. “We had a wonderful response that mirrored the warmth shown by others throughout Houston.”
More than 1,000 new cancer patients from areas wrecked by Katrina received care at M. D. Anderson. Another 811 patients from affected regions already were being treated at the institution when Katrina hit or were patients who returned for additional treatment following the storm.
Besides caring for patients’ physical needs, staff members from various areas — including psychiatry, chaplaincy and pastoral education, social work, case management and the employee assistance program — helped patients displaced by the hurricane cope with the issues they faced as a result of losing homes, possessions and even family members.
Many of the new patients already had started cancer treatment at their local hospitals when they arrived in Houston.
“Our teams worked with patients who came in on short notice and with inadequate records or a hazy understanding of their condition. Everyone was good about adjusting to these unusual circumstances,” Burke says.
Our physicians and nurses often became “detectives,” working with insurance companies and laboratories to find patient information and contacting the American Society of Clinical Oncologists and other professional organizations to track down hometown physicians.
“Treating these patients was a challenge,” Burke says. “But with a combination of the patients’ knowledge of their cancer, the relative standardization of many cancer treatments and the dedication of our staff, we managed without significant interruptions to the patients’ care.”