From prostate cancer to immunotherapy to genetic testing, UC San Francisco research is providing new insights and aiding in the development of new treatment strategies for cancer. Some of the latest research will be unveiled at the annual meeting of the American Society of Clinical Oncology (ASCO) held in Chicago from May 30 to June 3.
Marking the organization’s 50th annual gathering, the meeting brings together more than 25,000 oncology professionals from a broad range of specialties.
Under the theme “Science and Society,” the event will focus on progress made against cancer over the last five decades and will identify the challenges and promises ahead. Here are highlights of a few UCSF studies that will be featured during the meeting.
Delaying Treatment Following Return of Prostate Cancer Might Be Safe for Some Patients
Men with relapsing prostate cancer might be able to safely delay hormone treatment in certain cases, which would help them avoid significant side effects such as impotence, fatigue and weakened bones, according to a new study, a joint collaboration of UCSF and the Harvard School of Public Health.
The observational study of some 2,000 men provides new data on timing strategies of hormone therapy when prostate cancer relapse is detected by rising levels. The findings, which need to be confirmed in randomized trials, would be relevant to an estimated 60,000 men in the United States with so-called “PSA relapse,” in which PSA levels are heightened but patients experience no symptoms and tumors are not evident through scans or exams. Currently there are no standard guidelines for such patients to indicate when androgen deprivation therapy should be started.
The study was conducted within the national CaPSURE prostate cancer registry study developed at UCSF by principal investigator Peter R. Carroll, MD, MPH, chair of the UCSF Department of Urology. The CaPSURE registry tracks men with the disease to evaluate therapy benefits, quality of life, and other outcomes. According to first author, Xabier Garcia-de-Albeniz, MD, a research associate at Harvard University School of public Health, the study illustrates how less-aggressive treatment might provide the best benefits to patients.
“The observational data from CaPSURE were analyzed in a way that simulated a randomized clinical trial using novel statistical methods proposed by our colleagues at Harvard,” said June M. Chan, ScD, UCSF mentor for Garcia-de-Albeniz. “The results suggest little difference in outcome between immediate vs. delayed usage of androgen therapy after a rising PSA. However, because our data are observational, we cannot totally rule out that other clinical or demographic differences in the two groups may partially account for this result, and await the completion of an ongoing randomized clinical trial for confirmation.”
From UCSF, the authors include Chan, professor in the departments of epidemiology & biostatistics and urology; Alan T. Paciorek, programmer analyst; Stacy A. Kenfield, DSc, assistant adjunct professor of urology; Matthew R. Cooperberg, MD, MPH, associate professor in the departments of urology and epidemiology & biostatistics; and Carroll, leader of the prostate cancer program at the UCSF Helen Diller Family Comprehensive Cancer Center.
Study Provides Clues to Why Cancer Immunotherapy Works Better for Some Patients
A new study sheds light on why cancer immunotherapies work and why some patients respond to treatment while others don’t. The researchers at UCSF and UCLA found that while the cancer drug ipilimumab serves to reset the immune response, it functions best in patients with pre-existing high-frequency T cells that persist after treatment. The paper addresses two major questions: How do the immune checkpoint inhibitors work in patients, and can scientists potentially identify which patients respond and which do not?
“Our results help to explain how anti-CTLA4 treatment works in patients,” said Lawrence Fong, MD, a UCSF professor in the division of hematology/oncology. “We found that this treatment scrambles the T cells circulating in the patient, like shuffling of a deck of cards. In doing so, patients could potentially expand T cells that could recognize their tumors. Importantly, we also found that patients who survive longer actually hold onto their highest frequency T cells. This would suggest that cancer patients who benefit from this treatment have a pre-existing immune response to their cancer prior to treatment.”
From UCSF, the authors include Fong, and Yafei Hou, MD, MPH, a specialist at the UCSF Department of Medicine.
Tumor Sequencing Could Transform Cancer Care But Isn’t Yet Covered by Insurance
Over the last few years, remarkable advances in DNA sequencing technology have made it possible to perform highly accurate and rapid testing of patients’ tumors for genetic abnormalities, yielding information that holds enormous promise to improve upon cancer diagnosis and treatment. While next-generation tumor sequencing has moved from research labs to medical clinics, coverage policies have not yet been developed by most health insurance carriers.
In the new study, scientists conducted interviews with senior executives of seven large national and three regional health insurance plans in the U.S. The plans cover 125 million members. The researchers found that while most insurance carriers believe sequencing could potentially transform cancer care, some consider it experimental and a majority of those surveyed do not believe bioinformatics should be reimbursed.
“Because this technology is so new and complex, it will take quite some time – and extensive research – to understand the significance of individual mutations and how they impact the effectiveness of specific treatments for specific types of cancer,” said Kathryn A. Phillips, PhD, principal investigator of the National Human Genome Research Institute grant that funded the study. “At this juncture, where the technology is advancing faster than the clinical data in many ways, cancer patients and oncologists face the difficult decision of how and when to order these new and expensive tests which aren’t always covered by insurance and can cause significant expense for patients.”
From UCSF, the authors include Julia R. Trosman, PhD, assistant adjunct professor in the Department of Clinical Pharmacy; Robin Kate Kelley, MD, assistant professor of medicine in the division of hematology/oncology; and Phillips, professor of health economics and health services research in the Department of Clinical Pharmacy at UCSF, and director and founder of the UCSF Center for Translational and Policy Research on Personalized Medicine.
More information on abstracts that will be presented during the ASCO meeting can be found on their website.
UC San Francisco (UCSF), now celebrating the 150th anniversary of its founding, is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco.