Personalized Medicine at the Vernon Cancer Center

Cutting-Edge Treatment for Cancer
While traditionally cancer has been treated with surgery, chemotherapy or radiation, research has made cutting-edge treatments available to patients coming to the Vernon Cancer Center. By looking at the cell biology of a tumor, cancer specialists are now understanding more about how these cells grow and spread.

“By looking at the molecular level, we are better able to understand how cancers behave and grow,” says Jeffrey Wisch, MD, Clinical Director of the Vernon Cancer Center. “Through studying the receptors on the cell, we can gain important new information about how to treat a particular type of cancer in an individual patient. This permits us to move further from a ‘trial and error’ approach to a personalized form of treatment.”

Understanding Cancer Cells 
Having a better understanding of cancer cells, allows oncologists at the Cancer Center to deliver personalized cancer treatment. The Center works closely with our Pathology Department at the Hospital to determine whether or not certain cancer cells have specific mutations that can be treated with new drugs that are tailored to specifically target the tumor cells.

“We have set up specific protocols with our pathologists to help us better understand a patient’s cancer cells,” adds Dr. Wisch. “We know certain cancers have the possibility of having a mutation that will respond better to these new drugs. When a pathologist identifies one of the cancers with the potential to have a mutation, he sends the sample out to see if the patient might be a candidate for a specific treatment.”

Molecular Targeted Therapy
This treatment, known as molecular targeted therapy, is targeted to the mechanism that is causing the cell to be malignant. The drug targets this abnormal mutation to change the behavior of the cancer cell.

The use of targeted therapy in oncology has grown rapidly in recent years. Some of the current treatments using molecular assessment and targeted therapies at Newton-Wellesley Hospital include:

  • In the most common type of non-small cell lung cancers, approximately 20 percent have genetic changes in their tumors that allow them to be treated with approved targeted therapies against these mutations with a very high success rate.
  • In early stage breast cancer, patients may benefit from molecular tests to determine if chemotherapy should be added after surgery. Molecular tests are also used for all breast cancer patients to determine if targeted therapy, which markedly increases the response to chemotherapy, should be added to treatment.
  • Testing for a specific mutation in colon cancers helps determine the 60 percent of these cancers that respond well to a targeted drug. Testing on this mutation is currently being done at Newton- Wellesley for all recurrent colon cancers.
  • Certain drugs are currently being studied to treat recurrent ovarian cancers (and some breast cancers) that have mutations. In ovarian cancer, 30 percent of cancers have a specific gene mutation currently under study with targeted therapy. The Cancer Center is embarking on a clinical trial with Dana-Farber Cancer Institute to study a drug given to patients with this ovarian cancer mutation.
  • Fifty to 55 percent of metastatic melanomas have a mutation that predicts a high response to a newly approved drug.

“In the past, we have reported on standard characteristics of tumor cells such as tumor type and grade,” says Anthony Guidi, MD, Chair of Pathology at Newton-Wellesley. “Through recent research, we are now able to look at the characteristics of a tumor at the molecular level and determine if the patient is an appropriate candidate for more targeted therapy.”

The New Face of Oncology
Newton-Wellesley Hospital is now using this technology as a standard part of cancer care. “We are excited that this type of treatment is available to patients at the Cancer Center,” says Dr. Wisch. “We are grateful to work with institutions within the Partners system that have done much of the research to bring us these drugs – from the lab to clinical settings.”

The Cancer Center has been able to streamline the process of offering more molecular targeted therapies through its partnership with Pathology.

“This new face of oncology stresses the importance of a multidisciplinary approach to cancer care and requires a close collaboration with Pathology,” says Dr. Wisch. “We have worked as a team to improve the care we are able to offer based on the new drugs available.”

The treatment is also cost effective as patients are screened at the cellular level by Pathology and only patients with specific mutations are given the new drugs. In addition, identifying cancer mutations helps determine if certain clinical trials are an option for treatment. In current oncology research, many trials now focus on these molecular targets.

Some of the tumors that are tested by Pathology include lung, colorectal, renal cell and breast carcinomas, as well as malignant melanoma and chronic myelogenous leukemia. Dr. Guidi feels this is just the beginning of determining and defining exact blue prints of each person’s cancer.

“By determining these specific mutations and targeting those cells with certain drugs, we can increase our survival rates and lower the toxicity to the patient,” says Dr. Guidi. “The clinical significance of more and more mutations is being defined with each passing month. Our team at Newton-Wellesley is committed to working with our clinical colleagues in the Cancer Center to find the most efficient and effective ways to provide appropriate cancer diagnosis and treatment. We are committed to introducing the new research findings into clinical practice and collaborating with our team to bring this care to the Hospital.”

Molecular Profiling
Newton-Wellesley is also using this type of targeted therapy in breast cancer patients. “We use various testing to learn more about the specific cells of our breast cancer patients,” says Caroline Block, MD, Director of Medical Oncology, Auerbach Breast Center. “We are now conducting molecular profiling that allows us to look at the molecular make up of the cancer cell and determine the chance of the cancer spreading outside the breast to other parts of the body.”

Understanding the chance of cancer spreading allows Dr. Block and her team to have a better idea of how to proceed with treatment.

“This profiling works especially well in early stage breast cancer because it gives us a better idea of who will need chemotherapy,” she adds. “We are able to give certain therapies knowing it’s the right therapy for that patient. There are so many types of breast cancer – now, instead of treating all 40 year old cancer patients with the same regimen, we can provide personalized treatment geared towards their individual cells and abnormalities.”

The Cancer Center team is working together to individualize cancer care for each patient who comes to Newton-Wellesley Hospital.

“I am very excited about the future of this cancer therapy,” says Dr. Wisch. “As more mutations are being identified, new treatments are being developed. Learning as much as we can about the molecular level of cancer cells, will allow us to provide even more personalized cancer care at the Cancer Center.”

More Information
For more information about the Cancer Center at Newton-Wellesley Hospital, please call CareFinder at 1-866-NWH-DOCS (694-3627) or visit www.nwh.org/cancer.

Caroline Block, MD
Director of Medical Oncology at the Auerbach Breast Center
Dr. Block received her medical degree from the University of Michigan. She completed her residency at Beth Israel Deaconess Medical Center and her medical oncology and hematology fellowships at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. Dr. Block is board certified in internal medicine, hematology and medical oncology.

Anthony J. Guidi, MD
Chair of the Department of Pathology
Dr. Guidi received his medical degree from Boston University School of Medicine. He completed his residency in anatomic and clinical pathology at Beth Israel Deaconess Medical Center. Dr. Guidi is board certified in anatomic and clinical pathology.

Jeffrey S. Wisch, MD
Clinical Director of the Vernon Cancer Center, Associate Chief of Hematology/Oncology and Director of Inpatient Oncology
Dr. Wisch received his medical degree from Mount Sinai School of Medicine and completed his residency at the Hospital of the University of Pennsylvania. He completed fellowships in hematology at Brigham and Women’s Hospital and medical oncology at Dana-Farber Cancer Institute. Dr. Wisch is board certified in internal medicine, hematology and medical oncology.

 

 

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