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  • 1. A Publication ofM. D. Anderson 3 Clinical Trials Enrolling 4 Protecting the Heart Minimizing 7 House Call Detect ovarian ! 8 DiaLog Drug developmentCancer Center Studies available for cardiotoxicity cancer early by in academia ® brain tumor patients from cancer drugs recognizing the signs benefits everyone R E P O RT T O P H Y S I C I A N S NOVEMBER 2007 VOL. 52, NO. 11Outsmarting Brain CancerFinally, cause for optimism in glioblastoma treatment.By Dianne C. WitterDr. Charles Conrad explainshow Delta-24 will be deliveredintravenously to glioblastoma.I Delta-24 is a new-generation adenovirus therapy devel- t’s been called a viral “smart bomb,” oped by researchers at The University of Texas M. D. and with good reason. The name even Anderson Cancer Center. The virus targets the pathway of has a military ring: Delta-24. Mission: the retinoblastoma protein (pRb), a master regulator of cell growth that is deficient in many cancer cells. Researchers eradicate glioblastomas while leaving created a gene mutation in the virus that allows it to repro-critical nearby brain structures unscathed. duce only in cells without pRb; thus, in normal cells, Delta-The mission is even tougher than it 24 cannot replicate. But when injected into tumor cells, the virus replicatessounds. Unlike most other solid tumors, exponentially until the cells burst, each releasing about 10,000glioblastomas are not shaped in a defini- new copies of the virus. These copies spread out, attach to more cancer cells, and repeat thetive lump; they spread into crevices within process. The virus moves, wave-the brain, taking healthy tissue hostage like, throughout the tumor,as they go. (Continued on page 2)
  • 2. Outsmarting Brain Cancer (Continued from page 1) infecting and killing cancer cells without affecting normal cells. On the verge of important advances Targeting tumors with a viral smart bomb is only one of the avenues show- ing promise. After several decades in which no new drugs were approved for the treatment of brain tumors and sur- vival rates remained disappointingly low, there are now a variety of promising new medical treatments in the pipeline. They come close on the heels of the U.S. Food and Drug Administration’s approval in 2005 of the chemotherapy drug temozolomide for use in glioblas- toma. Temozolomide, when used in addition to surgery and radiation, extends median overall survival by Dr. Frederick Lang (right), professor in and director of clinical research for the 2.5 months—and a few people in the Department of Neurosurgery, and Dr. Juan Fueyo are working to bring Delta-24 early clinical trials of temozolomide are to clinical trials after finding success in the laboratory. alive years beyond what was expected. W. K. Alfred Yung, M.D., chair of immune system to the presence of ing to identify the genes and proteins the Department of Neuro-Oncology, epidermal growth factor receptor variant associated with gliomas to identify or believes temozolomide was the begin- III (EGFRvIII), a protein found on develop small-molecule drugs specifically ning of a positive trend in brain cancer gliomas that is believed to drive them to targeted to these molecular pathways. treatment. “We are just now on the cusp spread aggressively. The vaccine contains Some of the more common genetic of understanding much more about the a synthesized piece of the protein and a alterations in malignant brain tumors molecular biology of this disease, which stimulator to activate the immune sys- include the p53 tumor suppressor gene; is leading us down some innovative and tem, inciting it to mount a response, EGFR genes that control cell growth; very promising avenues,” he said. “For attacking the EGFRvIII and the gliomas platelet-derived growth factor and example, in addition to the Delta-24 it’s attached to. vascular endothelial virus, we’re also looking at a peptide In a phase II clinical growth factor (VEGF) vaccine, antiangiogenesis agents, and trial conducted at M. D. Some of the mice genes involved in cell epidermal growth factor receptor (EGFR) Anderson, glioblastoma growth and angiogene- inhibitors, in addition to retooling exist- patients whose brain were considered sis; and the PTEN ing chemotherapy drugs so they will tumors showed evidence clinically cured of (phosphatase and cross the blood-brain barrier.” of the protein on exam- tensin homologue) Charles Conrad, M.D., associate ination after surgical their brain tumors.” tumor-suppressor gene. professor in the Department of Neuro- removal were eligible – Dr. Juan Fueyo A number of signal- Oncology, adds, “I think we’re going to for the vaccine. transduction inhibitors see an explosion of new drugs for brain Preliminary results sug- are being tested for use tumors within the next 3 to 5 years, gest the vaccine is significantly increas- in brain tumors based on these molecu- and many of those are being developed ing the expected life span of patients lar signatures, including erlotinib, ZD at M. D. Anderson. We have a real in the study; participants have had a 1839, and AEE788 (which are EGFR optimism that advances are coming.” median overall survival of at least 18 inhibitors) and rapamycin and RAD001 Nationwide, only 1% to 2% of glioblas- months. Researchers found that the (which are mammalian target of toma patients survive long-term today. treatment can potentially keep the dis- rapamycin [mTOR] inhibitors). mTOR Dr. Conrad believes that within 5 or ease at bay for a period of time in up to inhibitors regulate the way tumor cells 10 years, that figure will have jumped 50% of glioblastoma patients. However, respond to nutrients and growth factors to 20% or even 30%. there is evidence that the tumors may and also control blood supply to the eventually circumvent the vaccine, so tumor through their effects on VEGF. Sneak peek at projects under way researchers plan to combine the vaccine Researchers at M. D. Anderson Researchers at M. D. Anderson with chemotherapy in the current study. expect to open two clinical trials of designed a vaccine that alerts the In other research, scientists are work- unique P13K inhibitors, PX-866 and2 OncoLog • November 2007
  • 3. BEZ-235, in glioblastoma patients in and colleague, Candelaria Gomez- surgery,” said Dr. Fueyo. “We have to be2008. The agents are expected to offer Manzano, M.D., assistant professor in cautious about extrapolating the resultsseveral advantages, including signifi- the Department of Neuro-Oncology. from animal studies, but the tumorscantly reducing the dose-limiting “We found only empty cavities and grown from these cells closely resembletoxicity common with P13K inhibitors. scar tissue where the tumors had been. human tumors, so we’re very optimisticThe agents will be tested in combina- Some of the mice were considered and excited to begin clinical trials.”tion with existing small-molecule drugs clinically cured of their brain tumors.” Glioblastoma is the most common,such as erlotinib and sorafenib, with It’s a big finding, albeit in very small and most deadly, of brain cancers. Ifthe expectation of blocking multiple subjects. Recently, the researchers found the results seen in mice turn out topathways. even more promising news about Delta- be indicative of the results in humans, Glioblastomas are highly vascular- 24. They showed that, in addition to Delta-24 may ultimately prove to beized, and the vascular system is thought killing tumor cells, the virus can target an important new therapy for humanto have a key role in their progression— and eliminate the actual stem cells glioblastomas. The Brain and Spinewhich has led investigators to look that initiate the growth of glioblastoma. Center at M. D. Anderson expects toincreasingly at using antiangiogenic “These cells are highly resistant to begin enrolling patients in the first clini-agents. “The antiangiogenic drug beva- chemotherapy and radiation, and they cal trial of the new viral therapy this fall.cizumab is one of the most promising fuel the re-growth of the tumors after (Continued on page 4)agents being studied right now,” saidDr. Yung. “We’ve seen very good early Clinical Trials in Glioblastomaresponses in studies combining it withthe chemotherapeutics irinotecan orerlotinib.” • A Phase II/III Randomized Study of M.D., and Frederick Lang, M.D. The CDX-110 Vaccine with Radiation goal of this clinical research study “Most chemotherapy drugs have not is to find the highest safe dose of and Temozolomide in Patients withtraditionally had success in brain tumors Delta-24-RGD4C that can be inject- Newly Diagnosed Glioblastomadue to their inability to cross the blood- Multiforme (2007-0263). Principle ed directly into brain tumors and intobrain barrier, which actively pumps out investigator (PI): Morris Groves, surrounding infiltrative normal brain.cytotoxic drugs as fast as we put them M.D. The goal of this clinical A second goal is to study the effectsin,” said Dr. Conrad. With an improved research study is to compare the of the drug on brain tumor cells.understanding of the biology of the effectiveness of giving temozolo-blood-brain barrier, researchers have mide with a CDX-110/GM-CSF vac- • Phase III Trial Comparing Conven-developed a way to retool existing cine combination to giving temozolo- tional Adjuvant Temozolomide withchemotherapies so that they will pene- mide by itself in patients with Dose-Intensive Temozolomide intrate this barrier. This could be achieved glioblastoma multiforme. Patients with Newly Diagnosedthrough modification of the chemical Glioblastoma (RTOG0525). PI: Markstructure or using carrier peptides or • A Randomized, Factorial-Design, Gilbert, M.D. The goal of this clinicalantibodies. For instance, M. D. Phase II Trial of Temozolomide research study is to compare twoAnderson researchers re-engineered Alone and in Combination with dose schedules of temozolomidethe chemotherapy agent doxorubicin to Possible Permutations of treatment in patients with braincross the blood-brain barrier. Phase I tri- Thalidomide, Isotretinoin and/or tumors. Researchers want to find outals of the resulting agent, RTA744, have Celecoxib as Post-Radiation if increasing the intensity of temo-shown encouraging results—including Adjuvant Therapy of Glioblastoma zolomide treatments after radiationone patient with complete resolution of Multiforme (2004-0662). PI: Mark will improve response. Researchers Gilbert, M.D. The goal of this clinical will study whether the response tohis tumor. Another agent under devel- research study is to learn if temo- temozolomide and the overall out-opment is 2-deoxy-d-glucose, which zolomide, when given alone or in come depend on whether the tumorinhibits the glycolysis process that brain combination with thalidomide, cells express the MGMT gene.tumors depend on for energy. isotretinoin, and/or celecoxib, is And then there is the new generation • Phase II Single Arm Trial of VEGF effective in treating newly diagnosedvirus, Delta-24. Researchers were excited glioblastoma multiforme in patients Trap in Patients with Recurrentby the degree of success they had when who have already been given radia- Temozolomide-Resistant Malignanttesting Delta-24 in mice. “The virus tion therapy. Gliomas (NABTC06-01). PI: John decompletely eradicated some glioblas- Groot, M.D. The goal of this clinicaltomas, a response that had never been • Phase I Trial of Conditionally research study is to find out if VEGFseen before,” said Juan Fueyo, M.D., Replication-Competent Adenovirus trap can help control glioblastomaassociate professor in the Department (Delta-24-RGD) for Recurrent multiforme or anaplastic glioma thatof Neuro-Oncology, who developed the Malignant Gliomas (ID01-310, pend- has recurred. The safety of VEGFtreatment in collaboration with his wife ing activation). PIs: Charles Conrad, trap will also be studied. q OncoLog • November 2007 3
  • 4. Outsmarting Brain Cancer (Continued from page 3) In this clinical trial, Delta-24 will Protecting the Heart be injected into brain tumors through Careful monitoring, early intervention can a surgically implanted catheter. After 2 weeks, the tumors will be surgically limit cardiotoxicity from cancer therapies. removed and examined. In future stud- ies, however, the virus may be delivered to the tumors via mesenchymal stem By Karen Stuyck treatment has become so much more cells, which would effectively serve as effective that, in many cases now, H a Trojan horse for the virus. Researchers eart disease is living with cancer resembles manag- at M. D. Anderson have discovered that ing a chronic disease like diabetes these stem cells preferentially home in one of the most or high blood pressure,” he said. common treat- American Cancer Society statistics indicate that the 5-year survival The antiangiogenic drug ment-limiting rate for all cancers has substantially side effects of cancer therapy. increased in the past 20 years, from bevacizumab is one of the 51% for patients diagnosed between Monitoring patients for most promising agents 1975 and 1977 to 66% for patients heart damage and managing diagnosed between 1996 and 2002. being studied right now.” the anticancer therapy to “We don’t want our patients to sur- – Dr. Yung minimize cardiovascular vive cancer and then die of a heart problem that might have been to tumors, even if a tumor exists in the complications are the keys avoided.” unique environment of the brain. By to dealing with the prob- Chemotherapy and even newer concealing the virus inside the stem biological and targeted cancer thera- lem, according to M. D. pies can weaken a patient’s heart. cells, it could be carried directly to the tumor without detection by the immune Anderson cardiologists. A study by M. D. Anderson cardiolo- system and, once inside, destroy it. Preventing treatment-related gists, published in the June 29, 2004, heart problems in cancer patients issue of the journal Circulation, Looking forward is especially important today, said reviewed the effects of 29 anticancer Glioblastoma is a formidable foe, and Daniel Lenihan, M.D., associate agents and concluded that every researchers say the key to outwitting it professor in the Department of class of cancer drugs can potentially won’t come from one drug or one treat- Cardiology and director of clinical damage the heart. ment; it will take a variety of approaches research in cardiology. “Cancer One of the most problematic and an arsenal of next-generation drugs and therapies. “We need to attack multi- Liza Sanchez, RCS, and Dr. Daniel Lenihan ple pathways at one time to outsmart study a cardiogram for signs of the cancer cells,” said Dr. Yung. “So, in chemotherapy-induced cardiotoxicity. addition to identifying new drugs, we need to test different treatments in com- bination to find the optimal approach.” For now, though, Dr. Yung stresses that there are many more options avail- able to brain tumor patients than in the past. “We now have a wide range of tri- als using different approaches and tar- geting different types and stages of the disease; there’s something for everyone,” he said. “There are many things we can do to increase a patient’s chance of survival and quality of life. “Most importantly, we can offer more hope,” he said. q For more information, call the Brain and Spine Center at 1-877-632-6789 or visit www.mdanderson.org/care_centers/ brainspinal.4 OncoLog • November 2007
  • 5. classes of anticancer drugs is the anthra- steroids, and slow infusions may can be critical,” Dr. Lenihan said.cyclines/anthraquinones, which include prevent or minimize such reactions. “We want to minimize the time adoxorubicin, widely prescribed for breast Careful monitoring for hypotension is patient is off that medication becausecancer, lymphoma, and other cancers. recommended for patients who have we understand how important it is.”These drugs can cause irreversible pre-existing cardiac disease. If recog- Educating other physicians aboutchronic heart failure or left ventricle nized early enough, these blood pressure new management techniques to limitdamage, said Edward T. H. Yeh, changes can be easily treated, Dr. Yeh toxicity during cancer treatment is alsoM.D., professor in and chair of M. D. said. vitally important, he said. He and otherAnderson’s Department of Cardiology. Recent research has provided useful M. D. Anderson physicians have givenThe mechanism is thought to be direct information for treating these therapy- presentations at the Heart Failuremyocardial injury due to formation of related heart problems. “Before we just Society of America to inform cardiolo-free radicals. Patients given these drugs recognized that people were at risk for gists about guarding against heart prob-need to be closely monitored for early a heart problem, but now we’ve refined lems during cancer treatment.signs of heart problems, he said, to who’s at risk,” Dr. Lenihan said. Last February, the first Cardiologylimit any cardiotoxicity. Cardiotoxicity can occur in any can- and Oncology Partnership symposium, Other chemotherapy agents have cer patient, though elderly patients or held at M. D. Anderson and chaired bya variety of toxic effects on the heart. those who already have pre-existing ill- Dr. Lenihan, offered health professionalsIf the total dose is high, cisplatin and nesses such as heart disease or diabetes a comprehensive review of cardiovascu-cyclophosphamide may produce prob- have the highest risk. This damage to lar complications related to cancer ther-lems ranging from hypertension to the heart can occur during treatment apy. A second conference will be heldchronic heart failure. Antimetabolites, or months afterward. next May in conjunction with Memorialsuch as 5-fluorouracil, can cause It’s important that cardiologists and Sloan-Kettering Cancer Center in Newischemia that, if untreated, can lead oncologists work together both to pre- York.to heart attacks. vent cardiotoxicity from occurring dur- Cardiologists and oncologists, Dr. The newer targeted therapies, ing cancer treatment and to treat any Lenihan said, may have different per-designed to attack only cancer cells, heart problems that do appear, Dr. spectives or focuses, but cancer patientsmay also cause cardiotoxicity. Mono- Lenihan said. He and other physicians with heart problems can only benefitclonal antibody drugs, such as beva- in the Cardiopulmonary Center often from a partnership between the twocizumab, cetuximab, and rituximab, consult with the cancer center’s oncolo- medical specialties and multi-disciplinary produce significant infu- gists or cardiologists outside of M. D. management of their treatment. sion reactions, such Anderson. They may be asked to evalu- Dr. Lenihan is also involved in as hypertension ate such issues as a new cancer patient’s research to detect cardiotoxicity after or hypotension, risk of cardiovascular disease or how to chemotherapy earlier than commonly in some cancer minimize the effects of cancer therapy used monitoring techniques. One of his patients. Anti- for a patient with pre-existing heart M. D. Anderson studies used cardiology- histamines, disease. specific blood tests—cardiac biomarkers acetaminophen, Depending on the individual case, B-type natriuretic peptide and troponin they might recommend adjusting the —to identify cardiotoxicity earlier than patient’s heart medications throughout standard methods. the course of chemotherapy, since The preliminary study will be repeated chemotherapy typically affects blood in a more definitive fashion at other pressure. A patient’s heart treatment institutions, Dr. Lenihan said. He is might also have to be changed because hopeful that this research will help of impending cancer therapy. identify chemotherapy-related heart For instance, a stent should not problems “at the onset of the problem be implanted because anticoagulants, so that we can devise ways to prevent which are necessary because clots it from becoming a real issue. otherwise may form in the stent, are “Right now, we just respond to contraindicated during chemotherapy. problems after they develop, but our Instead, Dr. Lenihan said, he would research using biomarkers gives a mech- probably recommend maximizing anism to react much sooner and devise medical therapy to manage the heart a treatment strategy to limit or prevent problems. such toxicity.” q Other patients might require going off clopidogrel, a blood thinner, for a For more information, call askMD period of time before having cancer Anderson at 1-877-632-6789 or visit surgery since the drug could adversely www.mdanderson.org/care_centers/ affect their ability to clot. “The timing cardiopulmon. OncoLog • November 2007 5
  • 6. Study Examines Diet, because we always assumed that we Pancreatic Cancer Gene were not eating enough fruits and Breast Cancer vegetables and the more we ate, the Therapy Shows Promise Recurrence Risk more protected we would be against in Preclinical Study Researchers have discovered that a cancer,” Dr. Jones said. A liposome-delivered gene therapy diet very high in fruits, vegetables, and However, he cautioned, “With these developed at M. D. Anderson has been fiber and extremely low in fat neither findings, it is imperative that we not shown to selectively kill pancreatic reduces the risk of breast cancer recur- discount the importance of a healthy cancer cells in mice while leaving rence in women nor increases the diet and its role in cancer prevention. healthy tissue unharmed. Researchers chance for survival any more than the It is important to remember that our say the results show promise for more nationally recommended five servings control group was eating the recom- effective treatment of pancreatic can- a day of fruits and vegetables. mended guidelines for fruits and cer—which has a five-year overall sur- The Women’s Healthy Eating Living vegetables.” vival rate of less than 4%, making it (WHEL) Study, whose results were Differing interim results have been one of the deadliest forms of the disease. published in the July 18 issue of seen in another trial, the Women’s The new therapy, named VISA- the Journal of the American Medical Intervention Nutrition Study, which BikDD, uses a gene-based targeting Association, enrolled more than 3,000 concluded that reducing dietary fat agent, or promoter, that is known to be women previously treated for early- intake was marginally associated with active in pancreatic cancer but not stage breast cancer. The comparison longer relapse-free survival of breast healthy tissue. The promoter was made group (1,551 women) followed a stan- cancer patients. However, the WHEL more active with the addition of a regu- dard “five-a-day” healthy diet, was Study was not designed as a comparison latory gene sequence and a two-step given written material regarding a investigation. transcriptional amplification system. healthy lifestyle, was offered four cook- Finally, researchers added an engi- ing classes during the first year, and neered version of the Bik gene (known received bimonthly newsletters. In “The WHEL’s findings are as BikDD) to the promoter and pack- contrast, the intervention group pivotal because we always aged everything in a liposome for (1,537 women) adopted a diet low in intravenous delivery to the cancer. fat, high in fiber, and with twice the assumed that we were not According to laboratory findings, the daily servings of fruits and vegetables; eating enough fruits and gene activity was minimal or absent these women were intensively moni- from healthy cells and even cell lines tored with frequent phone counseling vegetables and the more from other cancers. However, in pancre- sessions, were offered 12 cooking classes atic cancer, the BikDD gene forced cell we ate, the more protected during the first year, and received death in all lines tested, resulting in monthly newsletters. we would be against cancer.” prolonged survival, tumor shrinkage or No statistically significant difference eradication, and inhibition of metasta- – Dr. Lovell Jones emerged in either the breast cancer sis. And, because the selectivity of the recurrence or death rates in the two therapy was so strong, virtually no toxi- groups. During the study, 518 of the Dr. Jones explained that the WHEL city occurred. The findings were report- women—256 (16.7%) from the inter- Study also did not address whether a ed recently in the journal Cancer Cell. vention group and 262 (16.9%) from low-fat diet high in fiber, fruits, and “This looks like a promising the comparison group—had a recur- vegetables would alter the risk of pri- approach to gene therapy for pancreatic rence of their breast cancer, or devel- mary breast cancer; it did not take into cancer, and we are working to bring it oped a second primary tumor. A total account what participants were eating to a clinical trial,” said co-author James of 315 women, 155 (10.1%) from the prior to their enrollment into the study, Abbruzzese, M.D., professor in and chair intervention group and 160 (10.3%) healthy or not; and the outcome of the of the Department of Gastrointestinal from the comparison group, died during study could have been impacted by the Medical Oncology. A phase I trial could the study. improvement of breast cancer therapy be ready to open in less than two years. M. D. Anderson Cancer Center over the past decade. Senior author Mien-Chie Hung, enrolled 380 breast cancer survivors. Except with women of color, Dr. Ph.D., professor in and chair of the Lovell Jones, Ph.D., professor in the Jones said, “We made more strides in Department of Molecular and Cellular Department of Health Disparities and the treatment of breast cancer in the Oncology, is leading a team that con- the study’s principal investigator at last 10 years than we had in the 25 tinues to research ways to tailor the M. D. Anderson, said the study’s results years before that. It is very possible gene expression vehicle so that it were extremely surprising. that we are seeing the impact of better can target other cancers or even other “The WHEL’s findings are pivotal therapy on both sides of our study.” q diseases. q6 OncoLog • November 2007
  • 7. PHYSICIANS: THIS PATIENT INFORMATION SHEET IS YOURS TO COPY AND PASS ON TO PATIENTS. Recognize the Signs of Ovarian Cancer hile ovarian cancer W is the deadliest of the gynecological cancers, if it is detected early, The following symptoms are often the result of something less serious than ovarian cancer. But if you are experiencing one or more of these symptoms frequently for the first time, tell your gynecologist. it can frequently be success- fully managed and treated. Pelvic or Urinary Abdominal Urgency Unfortunately, ovarian cancer is Abdominal Bloating (need to go too often diagnosed in its later stages, Pain right away) when it has already spread beyond the ovaries. Last year 15,000 women in the Urinary United States died from this relatively Having Frequency Feeling Full Difficulty rare disease, which accounts for only (need to 3% of all cancers among women. go often) Eating The prognosis is much better when the disease is caught while it is limited to the ovaries. The survival rate Center say that a woman with any of or both ovaries are removed. Most among women diagnosed with early- these ongoing symptoms should discuss patients will later receive chemotherapy stage ovarian cancer is more than 90%, them immediately with a gynecologist. to kill any remaining cancer cells. according to M. D. Anderson’s Ovarian A full physical and gynecological exam Screening Clinic. can help determine the cause. If abnor- Risk factors malities are detected, special blood tests The exact causes of ovarian cancer The six symptoms and ultrasound can be used to look for are not known, but women may be at A problem in detecting the disease ovarian masses. increased risk for the disease if: is that early symptoms are often over- Even if you are frequently experienc- • Their mother, sister, or daughter looked because they’re vague and ing symptoms, ovarian cancer is still had ovarian or breast cancer. resemble those of more common ail- unlikely. More probable are a number of • They themselves have had breast, ments. To help women identify ovarian common illnesses, such as irritable bowel endometrial, or colon cancer. cancer, researchers at the University syndrome, which a doctor can rule out • They have a history of infertility of Washington recently determined before checking for ovarian cancer. or used fertility drugs. six specific symptoms of the disease There are currently no adequate • They are of Ashkenazi Jewish (see box). screening tests for ovarian cancer, heritage. The study’s lead researcher, Barbara though there are some clinical trials of • They have a mutation or abnormal Goff, M.D., reported that while all screening techniques at M. D. Anderson change in the BRCA1 or BRCA2 women have these symptoms occasion- open to women at average or high risk genes. This would indicate suscepti- ally, they should be brought to a doc- for ovarian cancer. Ovarian cancer bility to breast and ovarian cancers. tor’s attention if “it’s something new screening at M. D. Anderson’s Gyneco- to you and it persists for more than a logic Oncology Center typically involves For more information about the couple of weeks and occurs almost daily a discussion of your medical history and disease or ovarian cancer screening, or every day.” In the study, published family background; a physical and a go to www.mdanderson.org/diseases/ in the journal Cancer, most women pelvic exam; a transvaginal ultrasound, a ovarian. q with ovarian cancer reported experienc- radiologic procedure that provides a pic- ing at least one of these symptoms and ture of the ovaries; and a CA-125 blood usually had them 12 or more times test. Color-flow Doppler ultrasound, For more information, talk to per month. which measures blood flow in the ovari- your physician, or: Other possible indications of ovari- an vessels, may also be performed. • call askMDAnderson at an cancer include changes in bowel If you are diagnosed with ovarian 1-877-632-6789 habits; persistent gastrointestinal cancer, surgery is the next step. During • visit www.mdanderson.org. complaints such as gas, nausea, and surgery, doctors will confirm the diag- indigestion; and unexplained weight nosis and stage of the disease and November 2007 loss or gain. remove the cancerous tissue from the K. Stuyck Health professionals at the M. D. ovary and surrounding areas. Usually ©2007 The University of Texas Anderson Gynecologic Oncology the fallopian tubes, uterus, and one M. D. Anderson Cancer Center
  • 8. Nonprofit Org. U.S. Postage PAIDThe University of Texas Permit No. 7052M. D. Anderson Cancer Center Houston, TXDepartment of Scientific Publications–2341515 Holcombe BoulevardHouston, Texas 77030-4009www.mdanderson.org/oncologAddress Service RequestedDiaLog Advancing Drug Design in Academia The University of Texas M. D. Anderson Cancer Center By Garth Powis, D.Phil. program not because it isn’t viable but President because it isn’t profitable. John Mendelsohn, M.D. B etter. Faster. Cheaper. These three In the last 5 years, M. D. Anderson has Provost and Executive Vice President words best describe why the discov- brought a remarkable 13 drugs to clinical Raymond DuBois, M.D., Ph.D. ery and development of drugs in trial, and another six are slated for clinical Senior Vice President for Academic Affairs Stephen P. Tomasovic, Ph.D. academic research settings just makes trials in the coming year. Another 12 Director, Department of Scientific Publications good sense. agents are in the developmental pipeline. Walter J. Pagel Drug development is a multi-billion- Through M. D. Anderson’s Pharmaceutical Managing Editor John LeBas dollar industry in the United States and Development Center, we are able to carry Assistant Managing Editor around the world, yet an average of only out nearly every aspect of pre-clinical can- Dianne C. Witter four new cancer drugs are developed per cer drug development—from antitumor Contributing Editors Melissa G. Burkett ˜ Lionel Santibanez Tamara Locke year by big pharmaceutical companies— testing and pharmacokinetic studies to MannyMunch Joe Gonzales Lionel Santibañez Karen Stuyck each costing approximately $800 million state-of-the-art assay development and Sunni Hosemann M. Sutton Ann Angelique L. Siy Ann M. Sutton and taking anywhere from 8 to 14 years toxicology studies, FDA meetings, and Design The Very Idea® Design of work. And this is only for cancers with Investigational New Drug preparation The Very Idea® Photography large patient populations. Orphan cancers and filing. Ultimately, it is our patients— Jim Lemoine Photography Jim Lemoine are typically overlooked in drug develop- and all cancer patients—who benefit Editorial Board Michael Fisch, M.D., Chair Editorial Board ment efforts because the market is deemed from these new drugs and treatments. Michael Fisch,Vice Chair Lyle Green, M.D., Chair Lyle Green, Vice M.D. Therese Bevers, Chair too small to be profitable. But this is where Our goal is not to become a drug Therese Estey, M.D. Elihu Bevers, M.D. Robert Estey, M.D. Elihu Gagel, M.D. we, in academia, can step up to the plate company, but to enable and encourage Beverly Gagel, M.D. Robert Handy, M.D. and use our knowledge, resources, and our investigators to rapidly bring innova- Beverly Handy,M.D. Patrick Hwu, M.D. Maurie Markman, M.D. Patrick Hwu, M.D. expertise. tive findings to the point where they can Shreyaskumar Patel,M.D. Maurie Markman, M.D. David Schwartz, M.D. Shreyaskumar Patel, M.D. Our estimates indicate that we can be tested clinically. This approach provides Rena Sellin, M.D. David Schwartz, M.D. RandalSellin, M.D. Rena Weber, M.D. develop drugs at a small portion of the patients with access to therapeutic options Christopher Wood, M.D. Randal Weber, M.D. Christopher Wood, M.D. cost and time it takes for pharmaceutical that otherwise do not exist and allows OncoLog, M. D. Anderson Cancer Center’s report to physicians, is Anderson newsletter sent report OncoLog, M. D. a monthly Cancer Center’sto more companies to do so. As an academic insti- investigators to develop agents that will than 30,000 physicians throughout the nation and to physicians, is a monthly newsletter sent to more the world. Published by the Department of Scientific than 30,000 physicians throughout the nation and tution, we can lead the effort to discover be tested in our own phase I and II clinical Publications, OncoLog reports on innovative develop- the world. Published by the Department of Scientific and develop novel drugs and to pursue trials—enabling us to more quickly bring ments in research and reports on innovative develop- Publications, OncoLog treatment at M. D. Anderson. Current research and treatment at M. D. Anderson. ments inand previous issues are available online in innovative clinical trials for cancers with cancer drugs to patients. q English and previous issues are available online in Current and Spanish at www.mdanderson.org/oncolog. For editorial information, call 713-792-3305 or English and Spanish at www2.mdanderson.org/ email fewer patients. We are better equipped to scientificpublications@mdanderson.org. To refer depts/oncolog. For editorial information, call a patient or request information, call 1-877-632-6789 713-792-3305 or email scientific publications@ develop agents faster, cheaper, and more or 713-792-6161, or visit www.mdanderson.org. mdanderson.org. To refer a patient or request innovatively because we don’t face the Dr. Powis is director of the information, call 1-877-632-6789 or 713-792-6161, Made possible in part by a gift or visit www.mdanderson.org. from the late same obstacles as big pharmaceutical Center for Targeted Therapy Mrs. Harry C. Wiess. Made possible in part by a gift from the late and professor in and chair of the Mrs. Harry C. Wiess. companies—namely, to meet requirements Department of Experimental of profitability and market share. We can Therapeutics. take the initiative and pursue new ideas, whereas industry may close down a drug8 OncoLog • November 2007 ©2007 The University of Texas M. D. Anderson Cancer Center Printed on recycled paper