The Onco'Zine Brief

In this episode of the Onco’Zine Brief Peter Hofland reports from the 2019 annual meeting of the American Society of Clinical Oncology – ASCO – which was held May 31st – June 4th, 2019.

Hofland talks with:

- Dr. Hartmut Juhl, the Chief Executive Officer of Indivumed, a physician-led, integrated global oncology company. The company offers specialized products and services designed to support the discovery of biomarkers, drug development, clinical trials, and individualized treatment for patients with cancer, and

- Dr. Jeannie Hou, Vice President Clinical Development at Rakuten Medical, a company developing precision-targeted medicines through the development of a novel, proprietary photo-immunotherapy platform.

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In this episode of The Onco’Zine Brief, recorded during the annual meeting of the American Society of Clinical Oncology, ASCO, being held May 31 – June 4, 2019, Peter Hofland talks with Lee Schwartzberg MD, FACP, is a Medical Oncologist and Hematologist at West Cancer Center, Germantown, TN, and Dr. Shannon Westin, MD, MPH., FACOG, Associate Professor, Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, a clinical investigator with a focus on developmental therapeutics and the use of biomarkers to predict response and recurrence in gynecologic malignancies.

Today in The OncoZine Brief Hofland an hus guests discuss two different aspects of the treatment of cancer: palliative and supportive care and the treatment of Gynecological cancers.

Hofland's interview with Dr. Lee Schwartzberg confirmed the importance of Palliative and supportive care in the treatment of patients with cancer. In essence, Palliative care is focused on improving the quality of life for people living with a serious illness like cancer. People with cancer may receive palliative care at any time from the point of diagnosis, throughout treatment, and beyond. This kind of care helps patients and caregivers manage the symptoms of cancer and side effects of treatment.

In the second part of the program, Hofland and Dr. Shannon Westinwe spoke about the progress made in the treatment of Gynecological cancers.

While all women are at risk for gynecologic cancers, and this risk increases with age, when gynecologic cancers are found early, treatment is most effective. But, the diagnosis of gynecological cancers can be difficult. In America, every six minutes a woman is diagnosed with a gynecologic cancer. And, according to the American Cancer Society, this year alone an estimated be 92,000 women will be diagnosed with a gynecological cancer in the United States. Sadly, this will also result in a predicted 28,000 women killed by various forms of this group of cancers.

Some of these gynecologic cancers have been called “silent killers” because women are often unaware of the signs and symptoms associated with these cancers and do not catch them until it is too late.

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In this episode of The Onco’Zine Brief Peter Hofland report from the annual meeting of the American Society of Clinical Oncology – ASCO – which was held May 31st – June 4th, 2019.

The American Society of Clinical Oncology is the world's leading professional organization for physicians and oncology professionals caring for people with cancer. During the annual meeting Peter Hofland spoke with:

• Anna Protopapas, the president and Chief Executive Office of Mersana Therapeutics, a clinical stage biotech company developing antibody-drug conjugates – a very specific kind of targeted anti-cancer drug;
• Eliran Malki, the Chief executive officer of BELONG.life, the world’s largest social network for cancer patients and caregivers designed to gain a better understanding of the cancer patient journey, with the goal of optimizing treatment and outcomes;
• Dr. Rod Humerickhouse, asset strategy leader oncology at AbbVie, a highly focused research-driven biopharmaceutical company. As a major developer of anticancer drugs, AbbVie’s oncology scientists understand that outsmarting cancer takes a potent combination of courage, scientific expertise and strategy.

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This week The Onco’Zine Brief comes from Chicago, Illinois and the annual meeting of the American Society of Clinical Oncology (ASCO) being held May 31 – June 4, 2019. In this episode Peter Hofland talks with a Eugene Luskin, Chief Executive Officer of Redmond, Washington-based Vyrty.

As part of a growing push to let patients control and manage their own medical history, Luskin’s Vyrty has launched a mobile app called Sync.MD that is designed by healthcare professionals to lets users – patients - store and share their own medical records with doctors. The app is a Personal Health Records (PHR-) system operated directly on behalf of and by patients, making them the real guardians of their health data.

As the custodian of their own healthcare information, patients can keep all their health data in one place and easily share it with health professionals to streamline registrations, referrals, and coordinated care. For patients, it takes just seconds to sync with any computer in a fully secure and encrypted process.

For healthcare professionals, Sync.MD makes it easy to share data and information in real-time (as required by HIPAA) with anyone involved in providing or assisting their your patient’s healthcare needs

The web-based interface grantees easy accessing, uploading, or downloading of documents and does no require the installation of complex software. The system is also easier and more affordable than large electronic health records (EHR) systems developed by the likes of Epic Systems, Cerner and Allscripts.

With multiple challenges in accessing and sharing data via legacy EHR-system as a result of remaining interoperability problems, Sync.MD-developers have created an easy to integrated, and low-costs, system designed to benefit both patients and doctors.

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This week The Onco’Zine Brief comes from Chicago, Illinois and the annual meeting of the American Society of Clinical Oncology (ASCO) being held May 31 – June 4, 2019.

In this episode Peter Hofland talks with a Adil Akhtar, MD, an Oncologist and Palliative Care Expert, Associate Professor, Department of Medical Oncology & Hematology at the Oakland University-William Beaumont School of Medicine. He is also director, of Inpatient Clinical Operations at the Karmanos-McLaren Oakland Cancer Center in Michigan and Chief, Division of Palliative & End of Life Care, Michigan Health Professionals.

Bladder Cancer
Bladder cancer is the sixth most common cancer in the U.S., with 81,000 new cases diagnosed each year, and 17,000 deaths annually. The most common type of bladder cancers arises from the transitional epithelium and are called transitional cell or urothelial carcinomas.

Typically, the patient’s choice of treatment will depend on the invasion of the muscle layer of the bladder, and has traditionally involved surgery, chemotherapy and/ or radiation treatment.

Earlier this year, a new drug called erdafitinib, marketed as Balversa® (The Janssen Pharmaceutical Companies of Johnson & Johnson), was approved by the United States Food and Drug Administration (FDA).

This drug is part of a new crop of potentially life-saving drugs is radically changing what the future of cancer care looks like— and improving outcomes for patients suffering from some of the most prevalent cancers. In the United States erdafitinib, the first-ever personalized treatment for bladder cancer, is one of these drugs.

Immunotherapy is also increasingly used in advanced stages, but until now there have been no approved targeted agents for bladder cancer.

The way physicians approach the disease is rapidly transforming. Tailoring treatment in accordance with the patient’s precise genetic mutation or biomarker is quickly becoming the new standard in cancer care. This is in contrast to the traditional way of thinking in which cancer was specifically focusing on an organ or body part (i.e. brain cancer, bladder cancer, breast cancer, etc.).

The use of targeted therapies in bladder cancer is still an emerging field of research— but the apparent success of erdafitinib showcases the promise they may hold.

Palliative Care Expert.
In addition to being an oncologist, Dr. Akhtar’s medical specializations also include, palliative care and end of life/hospice care. He believes that everyone has a right to decide what kind of medical care they want. He is very passionate about the healthcare living will and advance care planning. He has founded Advance Care Now to help people understand and make decisions about advance care planning.

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In this edition of The Onco’Zine Brief Peter Hofland talks with Mr. Isaac Israel, the CEO of Kitov Pharma, a pharmaceutical drug development company developing new options to treat osteoarthritis pain and hypertension simultaneously, as well as novel anticancer drugs.

The company is developing an investigational drug called NT-219, a novel small molecule drug designed to targets two signal proteins that are part of an anti-cancer drug resistance mechanism. 
Based on recent findings, Kitov researchers demonstrated that NT-219 binds directly to the two proteins.

In previous preclinical models where NT-219 was administered in combination with various oncology therapies, outstanding efficacy in preventing acquired resistance and reversing tumor resistance was demonstrated.

Immuno-oncology is increasingly recognized as the future in cancer therapy and many immuno-oncology candidates, including NT-219, have been identified and are currently being tested in preclinical studies or the clinic.

Founded upon the key principles of the immune response, Immuno-Oncology research seeks to understand how the body’s natural defenses, can be leveraged to empower antitumor immunity.
Immuno-oncology is different than traditional cancer treatments.

It works by augmenting the immune system’s natural ability to see and eliminate cancer cells much in the same way it protects us against infection from viruses and bacteria.

As a living, dynamic system, the immune system is able to detect cancer anywhere in the body, which is especially important in treating patients with cancers that have spread or metastasized to other organs.

Recent clinical success has resulted in the approval of a number of novel immuno-oncology therapies, both alone and in combination with other treatments, for nearly 20 types of cancer, including advanced solid tumor and blood cancers as well as cancers with a specific genetic defect resulting in a high frequency of mutation, regardless of tissue type.

In bladder cancer, melanoma, and certain types of lung cancer, these immuno-oncology therapies have received approval by the Unites States Food and Drug Administration (FDA) as first-line treatment, replacing or, in the case of combination therapies, improving conventional treatments like chemotherapy.

Immuno-oncology therapies are also FDA-approved to treat some patients for whom prior treatments were ineffective. Today, clinical trials are ongoing to test the benefits of Immuno-oncology agents in many other types of cancer.

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In this edition of The Onco’Zine Brief Peter Hofland talk with Dr. Lisa Stearns, the founder and medical director of Center for Pain and Supportive Care, in Phoenix, Arizona.

An internationally recognized Interventional Pain Specialist, board certified in hospice and palliative medicine and pain management, Dr. Stearns’ passion for changing the face of acute and chronic pain-treatment is evidenced by her ongoing care for her patients and her active research to find a better way to manage pain.

In addition to her work at the Center for Pain and Supportive Care, Dr. Stearns has authored numerous research articles and frequently speaks at medical society meetings around the world to share her knowledge and her passion to help her patients.

Cancer and cancer treatments can be painful. And patients often experience pain from surgery - from tumors pressing on bones, nerves, or organs and from chemotherapy and radiation. But each of these kinds of pain can be controlled and kept at a bearable level.

Dr. Sterns and her co-workers at the Center for Pain and Supportive Care work with cancer patients to develop a unique pain-management and rehabilitation-plan, based on a patient’s type of cancer.

Using a palliative care model Dr. Stearns brings together a team of healthcare professionals to help create the best possible quality of life for her patients and their overall health and wellness.

As a nation we battle an escalating opioid-overdose crisis – driven by synthetic opioids such as fentanyl but also tramadol and other drugs. Based on the latest data, this crisis claims more than 100 lives per day.

In their response to this crisis, the government has enacted tougher new laws and regulations on opioid prescribing. These laws are, however well-intentioned, also restricting access to opioids for cancer patients. At the same time, opioid-use, has an addiction stigma among many patients with cancer.

But, how common are opioid-related deaths in patients with cancer? To answer this question, researchers at the Duke University School of Medicine conducted a retrospective review of death certificate data from the National Center of Health Statistics, which provides information about the cause of death as well as and the contributing factors. The researchers looked at data from deaths due to opioids from 2006 to 2016.

They calculated the opioid death incidence from the estimated cancer survivor population, as well as the total population of the United States. The researchers found that from 2006 to 2016, about 900 deaths were related to opioids in patients with cancer.

However, this was compared with about 200,000 deaths in the non-cancer population.
Opioid deaths in both groups did increase over time, from about 5 to almost 9 per 100,000 people in the general population and 0.5 to 0.7 per 100,000 in the cancer patient population.

The researchers noted that in real, practical terms, the volume of overdose deaths in patients with cancer is very small. It increased from 59 patients in 2006 to 102 patients in 2016. The researchers involved in this study found that deaths from opioid abuse, as the primary cause of death, is about 10 times less likely to occur in patients with cancer.

Healthcare professionals like Dr. Lisa Stearns are committed to help cancer patients with pain management designed to improve the individual’s health related Quality of Life.

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In this edition of The Onco’Zine Brief Peter Hofland talks with Dr. Salman Hyder, Professor in Tumor Angiogenesis and professor of biomedical sciences in the College of Veterinary Medicine and the Dalton Cardiovascular Research Center at the University of Missouri, in Columbia, Missouri.

Together with a team of researchers Dr. Hyder found that a combination drug therapy, reduces the spread of triple negative breast cancer to other locations of the body by 50%

A breast cancer cell is like a house with three locks on the front door. Keys, or receptors, allow drugs to unlock the door and kill the cell. However, in triple-negative breast cancer, these keys are absent, thereby resulting in few options for drug therapy.

Until now.

A protein called p53 suppresses and kills cancer in people.

However, in contrast - a defective, mutant form of p53 helps cancer cells grow and multiply.

Triple negative breast cancer lacks ways to treat the cancer with hormone therapies or anti-HER2 targeted therapies. While chemotherapy can work well in Triple Negative Breast cancer – and a patient may even respond better to chemotherapy than some other types of breast cancer - these drugs are toxic, and non-specific.

Research has shown that most people who die as the result of breast cancer, in particular women with triple-negative breast cancer, do so following metastasis, or spread of the cancer to other organs in the body. Triple negative breast cancer lacks ways to treat the cancer with hormone therapies or anti-HER2 targeted therapies.

While chemotherapy can work well in Triple Negative Breast cancer – and a patient with Triple Negative Breast cancer may even respond better to chemotherapy than patients with other types of breast cancer – chemotherapeutic drugs are generally toxic, and non-specific.

Dr. Hyder and his team wanted to see if a new combination therapy could provide a new, non-toxic targeted approach for treatment. In a preclinical study with two previously discovered drugs —one that restores the p53 protein’s ability to kill cancer cells and another that targets the blood vessels in order to kill cancer cells — they observed an effect on metastatic triple negative breast cancer.

And according to the researchers, the results are promising. Dr Hyder noted that the cancer did not spread as fast when both drugs were given separately, and a little more with the combination of the two agents.

The two investigational drugs, APR-246 and 2aG4, are currently in clinical trials. Researchers hope that these findings will help enhance personalized treatment for breast cancer by reducing existing cancer cells and preventing the spread of the cancer to other parts of the body.

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In this edition of The Onco’Zine Brief Peter Hofland talks with Greg Van Wyk, Chief Executive Officer and Chief Medical Officer of Noxopharm, a clinical-stage Australian drug development company with offices in Sydney, New York and Hong Kong.

The company is developing a number of drug candidates including an advanced dosage formulation of the generic anti-cancer agent called idronoxil, which is designed to specifically target cancer cells, rendering them less able to survive radiotherapy. The drug is marketed as Veyonda®

Radiation seeks to kill cancer cells by damaging their DNA beyond any ability of the cancer cell to repair that damage.

However, all cells have a well-developed mechanism to repair DNA damage. And if a cancer cell is successful in repairing the damage caused by radiation designed to kill it, and survives, therapy is unsuccessful.

Scientists have developed a number of drugs designed to block that repair mechanism.
This means that more cancer cells can be killed following radiotherapy.

Unfortunately, many of these agents have not yet been successful. One reason is that they do not discriminate between repair mechanisms in cancer cells and repair mechanisms in healthy cells. And these drugs also increase the toxic side-effects of radiotherapy, countering any benefit from their use.

Idronoxil is different because it only blocks repair mechanisms in cancer cells... as a result, healthy cells remain unaffected. But in order to block the repair mechanism, idronoxil needs to be present on a continuous basis. When it is not present, the repair process continues unabated.

Researchers at Noxopharm have been able to develop a formulation of idronoxil that keeps the agent in the body in an active form for long periods of time.

The result is a continuous anti-cancer effect for as many days as the drug is administered. The drug has also being studies as an adjunct therapy to a standard of care chemotherapy drug.

The purpose of this approach is to increasing the sensitivity of widely-used chemotherapies while, at the same time, reducing many the well-documented damaging side-effects.

Earlier this year data from the first series of pre-clinical studies confirmed that idronoxil activates the cells associated with both the innate and adaptive immune systems. Noxopharm’s Veyonda® works in tandem with both chemotherapy and radiotherapy. The drug is designed to increasing the number of cancer cells killed by those treatments.

But the drug goes a step further when it acts as an immuno-oncology drug by switching on the body’s first-line immune defense mechanism. This is the main mechanism responsible for fighting cancer. What distinguishes Noxopharm’s investigational drug is that it works with, not against the body’s defenses against cancer.

Chemotherapy and radiotherapy are destructive treatments. Although they are designed to kill cancer, they can also damage healthy cells. And unfortunately they can also damage the defense mechanisms that the body relies on to fight cancer. The end result with standard chemotherapy and radiotherapy is a restricted anti-cancer effect because those treatments may also have disabled the body’s defense mechanisms. 

The aim NoxoPharm’s treatment is that it ensures that the immune system is switched ON and Primed to kill any cancer cells that survive the chemotherapy and radiotherapy. 

This early defense system is known as the innate immune system and is very effective at detecting and eradicating abnormal cells such as cancer cells. Noxopharm’s Veyonda® is considered to be a first-in-class activator of the innate immune system. This is the system, that scientists increasingly are beginning to see, must be activated if a cancer is to have any chance of being permanently eradicated.

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In this edition of The Onco’Zine Brief Peter Hofland talks with Charlie Covert, Vice President & General Manager Targeted Drug Delivery, Restorative Therapies Group - Pain Division at Medtronic, about opioids and pain management in patients with cancer.

While considered safe, reliable, and effective for all types of pain, opioids are also a potentially abuseable drugs. And the public health consequence of opioid abuse, is really bad.

More than 11.5 million people abused prescription opioids. As a result, every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.

The Centers for Disease Control and Prevention estimates the total economic burden of prescription opioid misuse in the United States alone, to be $78.5 billion dollar each year.
This includes the costs of health care, lost productivity, addiction treatment, and the involvement of the criminal justice system.

A review of latest information also confirms that many steps to mitigate and reduce the risks associated with long-term systemic opioid use, including misuse, addiction and overdose -- have failed – leading to the Opioid Crisis we see today.

The burden of cancer continues to increase on a personal and societal level – and the National Cancer Institute projects that the yearly cost of cancer treatment in the United States will increase to $157 billion in 2020.

And pain is prevalent in all cancer patients. A recent study published in the journal of the American Medical Association confirms that 55 percent of cancer patients, undergoing active treatment, report pain.

Pain has been identified as a preventable reason for hospital admission and is associated with more than 40 percent of cancer Emergency Room visits. And despite increased health care utilization cost, in most cases, liberal oral opioid use for cancer pain, remains the standard of care. So, what can be done to provide better care for patients? Are their alternatives?

In this episode of The Onco’Zine Brief Hofland and Covert talk about Medtronic, a company with a 40-year history of developing medical devices.

One of their options to help patients with acute and chronic pain involves Targeted Drug Delivery.

And the results of this approach are noteworthy.

In one study published in Neuromodulation, a peer-reviewed journal, patients report a reduction in pain scores after receiving targeted drug delivery. The journal also reports that more than 51% of patients completely eliminated the use of other prescribed opioids within 12 months.

Another study, this one published in the Journal of the American Medical Association, shows that using targeted drug delivery may also reduce health care utilization and cost for cancer-pain patients.

This study found significant cost savings to payors, with fewer inpatient visits, shorter inpatient length of stay, and fewer emergency department visits.

This good news for doctors helping their patients

It’s good news for friends and family members of cancer patients

But above all, it’s good news for cancer patients suffering from acute and chronic pain.

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