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Regional Oncology Update - Fall 2003 (click here to download as a PDF)
Innovative Lung Cancer Treatments
Despite significant advances in imaging, radiation, drug therapies and surgery, the treatment of lung malignancies remains largely palliative. Systemic therapies, including targeted therapies have largely failed to produce curative regimes for those tumors, which have not been completely surgically excised. Radiation therapies have not been able to address the systemic nature of the process and have hardly improved the local control of advanced stage nonsmall cell cancers.

Over the past two decades, we have added significantly to the armamentarium of palliative approaches. The Evansville Cancer Center has obtained national and indeed international attention for the implementation of interbronchial radiation therapy, laser induced fluorescence endoscopy (LIFE) and lately the application of Intensity Modulated Radiation Therapy (IMRT) to the chemo radiation approaches to palliative and neoadjuvant therapies.

Peer reviewed scientific articles have been produced either as individual reports or as participants in group investigations (1,2).

We have reinvigorated our interbronchial program over the past two years and are in process of revamping the fluorescent endoscopy program. In excess of 1000 HDR brachytherapy treatments have been delivered to obstructing lesions of the bronchi with generally successful results. We have pioneered the outpatient approach at our institution. Lately, we have interpolated this approach with systemic therapies and IMRT to limit morbidity in appropriate patients.

In the absence of curative regimens, we have an obligation to continue to pursue palliative approaches, which are highly efficacious and present low morbidity.

Over the next several months we will address an inter group approach which we hope will include the talents of ourselves, willing surgeons, pulmonologists, imaging specialists and medical oncologists to aid this unfortunate group of patients.

- Al Korba, M.D., FACRO, Radiation Oncologist, Evansville Cancer Center
1) Lam, S; Kennedy, T; Unger, M; Miller YE; Gelmont, D; Rusch, V; Gipe, B; Howard, D; LeRiche, JC; Coldman, A; Gazdar, AF. Localization of Broncial Intraepithelial Neoplastic Lesions by Fluorescence Bronchoscopy. Chest, 1998. 2) Korba, A: Wisnoski, P. Appropriate Use of Endobroncial Radiation. Journal of Bronchology, April 1995
Innovative Treatment For Non-Small Cell Lung Carcinoma (Chemo Light)
Non-small cell lung cancer (NSLC) has traditionally been one of the leading causes of cancer deaths in the United States. Over the past several years there has been a number of important developments and innovations in the treatment of this devastating type of cancer. These include interbronchial radiation therapy, as well as, exciting data which supports the concepts of induction chemotherapy and adjuvant chemotherapy. However, one of the more novel treatment options emerging from clinical trials is the utilization of specifically targeted biological agents.

The use of chemotherapy has been well established in the treatment of NSLC for the past several decades. This involves the use of multiple cytotoxic agents which result in cellular death and hopefully has the biggest cytologic reduction in the malignant tissue. Chemotherapy typically has significant toxicity secondary to non-specific cell death of normal tissue. The concept of targeted biological agents against the malignant lung cancer cells has centered around a group of emerging
drugs. These agents target new blood vessel growth reducing essential blood flow which retards tumor growth. However, two new exciting approaches include the use of monoclonal antibodies and small molecules. The monoclonal antibodies target the tumor cell surface receptor while the small molecules target intracellular pathway from the receptor. As a result, both agents alter intracellular messaging and consequently growth of the tumor.

The EGF receptor is a surface protein that is commonly expressed on most lung cancers as well as many other solid tumors. This receptor is the first step in a complex cascade of receptor activation which is followed by intracellular phosphorylations of proteins and then ultimately results in cancer cell growth. Iressa and Erbitux are two emerging drugs that seem to have exciting potential in the treatment of non-small cell lung cancer. Erbitux, which is still in the clinical trial phase, is a monoclonal antibody which binds to and inhibits the surface EGR receptor, resulting in the shutting down of the internal messenger system and ultimately cell activity.

However, Iressa is an exciting agent that is currently out of clinical trial and is showing promising results with minimal toxicity. Iressa is a unique small molecule which binds to tyrosine kinase. Iressa's inhibition of these specific intercellular proteins, activated by the surface EGF receptor, shuts down the messenger cascade to cell production. Iressa which inhibits this very unique protein has a very specific point of action inhibiting cell growth of the tumor but has very little toxicity because it has no other activity in any other cells. Iressa's mechanism of action is not fully understood. It was designed to inhibit growth stimulatory signals by blocking several tyrosine kinases, the most important one of which is associated with the HER-1/tumor growth factor surface receptor. This blocking results in the inhibition of cell proliferation and consequently an increase in cell death. What is exciting about this therapy is that it is an oral tablet administered once a day with minimal toxicity.

In April of this year, The United States Food and Drug Administration granted accelerated approval for Iressa tablets for treatment of non-small cell lung carcinoma in patients whose disease had progressed despite treatment with a standard first line based chemotherapy regimen. They approved Iressa based on findings from a phase two clinical trial in which two-hundred-sixteen patients, who had previously failed standard first line therapy, showed a meaningful response rate. Patients receiving a 250 mg oral tablet of this agent had a 14% response rate. The average responder had a 50% or greater reduction in the tumor size with the duration of response lasting between four and eighteen-plus months. More importantly, in a subsequent analysis, a sub-group of patients emerged. They were women with adenocarcinoma of the lung who had as high as a 30% response rate. Unfortunately, cures are not expected with Iressa. Two large randomized control trials where Iressa was utilized as first line therapy in combination with standard platinol based chemotherapy, showed no prolonged benefits.

As new targeted agents for the treatment of cancer emerge we will continue to see our paradigm of treatment change. While we have accepted that advanced stages of certain malignancies are not curable and will remain incurable, using relatively non-toxic agents to prolong survival with a meaningful quality of life is possible. Advanced disease with an expected rapid decline will become a more chronic disease in which symptoms can be palliated and patients maintained in a more meaningful lifestyle.

- Rick Ballou, M.D., PhD, Medical Oncologist, Evansville Cancer Center

Prostate Cancer Awareness Campaign - "Bob Dole Speaks Out"
Evansville Cancer Center kicked off its 2003 prostate cancer awareness campaign with former Senator Bob Dole on Saturday, August 23, 2003 at the Centre, downtown Evansville. The day's events opened with a luncheon for VIPs and sponsors, underwritten by Pfizer.

After the meal, Dr. Brian Geisler, a social psychologist, research scientist and recipient of the American Cancer Society grant, presented "The Quality of Life Following Treatment for Clinically Localized Prostate Cancer".

Everyone attending the luncheon received "Great Political Wit: Laughing (Almost) All The Way to The White House" autographed by Senator Dole and had their picture taken with him. As a prostate cancer survivor, he shared the story of his personal battle with prostate cancer emphasizing the importance of early detection for this disease.
Click here to view photos from this great event!
"Prostate Cancer: Speaking Man to Man" Television Program
On Tuesday, September 9th, 2003 from 8 to 9 p.m. Mike Blake of 14 WFIE hosted "Prostate Cancer: Speaking Man to Man" produced by the Evansville Cancer Center. This program featured urologists from the Tri-State area, oncologists from Evansville Cancer Center, and local prostate cancer survivors. In addition, viewers had the opportunity to call into WFIE's studios and have their questions answered live by a panel of physicians. Click here for photos and more information!
Free Prostate Cancer Screenings in Our Community

Evansville Cancer Center coordinated several prostate cancer screenings in the community. The screenings were provided free of charge compliments of an AstraZeneca grant and assistance by LabCorp, who processed the PSA blood tests. Several urologists generously donated their time to provide digital rectal exams as part of the prostate cancer screening.

As of October 2003, 328 men were screened for prostate cancer. Of that number, 12 men were found to have PSA's of 4 or higher and were instructed to schedule an appointment with their primary care physician or a urologist for further evaluation or testing. Alarmingly, almost one-half of the men who participated in the screenings had never had a PSA blood test. All of the participants were given educational materials on prostate cancer.
Click here for photos and more information!

Evansville Cancer Center would like to thank those who participated and assisted in any aspect of the 2003 prostate awareness campaign!

Skin Cancer Awareness Taken to a National Level!
Robin Lawrence-Broesch, Marketing Director for Evansville Cancer Center, has caught the eye of the national media. She was diagnosed with malignant melanoma last March 2002 and knows first-hand the emotional reactions of being told she had cancer.

Because of her personal perspective regarding melanoma, she has become involved in organizing free skin cancer screenings and offering educational programs to the public. She has shared her personal testimony through health fairs, public events, industry in-services, and schools with the goal of educating our community on the dangers of tanning and the need for appropriate screenings.

In the November 2003 issue of SELF magazine, Robin Lawrence- Broesch was featured in an article entitled "A Dark Secret", which addresses the dangers of indoor tanning. She agreed to the interview appearing on page 52 in hopes of changing the way tans are viewed and the resulting consequences. The article in SELF magazine was read by a producer of the Barbara Walters daily program on ABC, The View. They called Evansville Cancer Center requesting her to come to New York City and appear on their program. Lawrence-Broesch has agreed to the interview and will be traveling to New York City in early January 2004.

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