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Beyond Chemotherapy

Fighting cancer has never been easy. But new research — much of it being done in Southern California — is pointing toward a future in which patients will receive precisely targeted treatments that are more effective and have fewer side effects.

“The biggest advance is the move away from traditional chemotherapy, which is very difficult for the patient, and which not everyone will respond to,” said Judith Gasson, director of UCLA’s Jonsson Comprehensive Cancer Center. “We are moving toward the use of more therapies targeted against the DNA mutations driving the tumor’s growth. Typically these therapies have few side effects that are mostly mild, and many can be taken as a pill.”

Researchers at USC’s Norris Comprehensive Cancer Center and the Loma Linda Cancer Center are finding ways to zero in on specific types of cancer with specialized treatments, ranging from new drugs to robotic surgical procedures.

For the past 20 years, Loma Linda has been at the forefront of a technology called proton therapy, said Dr. Mark Evan Reeves, director of the Loma Linda Cancer Center. Proton therapy’s ability to target specific cells has been especially useful in treating cancers that were once difficult to isolate.

“Radiation is actually a very useful treatment for liver tumors, but the problem has been that it destroys too much of the normal liver, so that it can’t be used in most patients,” Reeves said. “Proton therapy makes it feasible to just home in on the actual tumors themselves.”

A similar approach is practiced at the USC Norris Comprehensive Cancer Center, where doctors look at the mutational signature of each patient’s tumor to find the right treatment. Dr. Stephen Gruber, director of the Norris center, said the next step will be dynamic tumor monitoring that will enable doctors to pick the most effective drug for each patient.

Such research will not only help develop new drugs but will limit drug resistance. “We have many studies going on right now to help understand why tumors become resistant to particular drugs and that will allow us to preemptively avoid tumor resistance with combination therapy,” Gruber said.

Reeves said investments in basic research (like mapping the human genome) have allowed doctors to better understand how cancers work. This understanding has resulted in the formulation of new drugs that can target specific cancers like gastrointestinal stromal tumors, which, until recently, were almost always fatal. They can now be treated with an 80% to 90% success rate.

Doctors expect more success stories in the years ahead. “There are cancers right now that are almost certain death sentences,” Reeves said. “They are the ones that we have not made any good progress on, and that in 10 years will absolutely have high success rates of treatment.” 

At UCLA, researchers are testing therapies that use patients’ own immune systems to identify and destroy tumors. “This is a broadly collaborative effort involving faculty across campus and at our partner institutions,” Gasson said.

When it comes to surgery, robotics is becoming an increasingly useful tool for tumor removal. “[Robotics] decreases length of stay, decreases complications and enhances outcomes,” Gruber said.

Doctors employing robotics have had particular success in treating gynecological cancers while preserving fertility. Gruber cites an example of a 28-year-old woman who was diagnosed with cervical cancer and was treated with a robotic surgical procedure developed by Dr. Laila Muderspach of USC. Not only did the woman end up cancer-free, she eventually gave birth to three healthy children.

Precision treatments are expected to get a boost thanks to efforts like the Encode Project, which is building a comprehensive list of functional elements in the human genome, Reeves said.

“The information from that really makes a lot of new approaches to developing drugs available,” he said. “So I think that probably by itself is going to be the main difference that we will see 10 years from now, where we will have ways of treating cancers using targeted treatments that we don’t have right now.”

Thomas McLean, Brand Publishing Writer

Copyright © 2014, Los Angeles Times
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