العربية

Archive for June, 2015

New insights in lung cancer treatment

Apar-Kishor-Ganti-Oncology-300x200
APAR KISHOR GANTI, MD

In the past decade, we’ve come a long way in our knowledge of lung cancer. Until then, we had only a basic understanding of the tumor cells – and chemotherapy helped only a small percentage of patients.

We knew very little about lung cancer cells. We only knew about “small cell lung cancer” and “non-small cell lung cancer,” which basically was everything else. Today, from 10 to 15 percent of lung cancers are the small cell type.

We knew there were differences among these “non-small cell” cancers. But we didn’t have the tools to identify them, and we didn’t know how to treat them. Everyone got the same chemotherapy treatment, which was very effective in some cases – but not for many.

That changed when drug called Iressa was introduced in the U.S. This drug helped a small minority of patients – and they responded dramatically. Their tumors disappeared in a matter of weeks. Unbelievable!

This led to research to find out more about these patients. This also started a revolution in understanding different sub-types of non-small cell lung cancer. Today, using sophisticated tests, we can identify the main mutation causing lung cancer in a significant proportion of patients.

This research has led to targeted treatments we use today, with much greater success. New drugs have been developed to treat two of these lung cancer sub-types. These drugs primarily help people who have not been smokers – but have developed lung cancer from other toxic exposures, like radon.

Erlotinib, Afatinib, Pemetrexed, Crizotinib and Ceritinib are drugs that that we use today – to treat some of these specific types of lung cancer. Many of these drugs and others like these are still in clinical trials, to study their effectiveness. While we still don’t have all the answers, and still don’t have drug treatments that help everyone, we’ve come a very long way.

Several more medications are in clinical trials. We’re continually looking for more answers, trying to help many more lung cancer patients. But our progress in the past 10 years has given all lung cancer patients – and medical specialists like me – more hope.

At Nebraska Medicine, our service is designated by the National Cancer Center as a Lung Cancer Alliance Screening Center of Excellence. This reflects our team’s experience as well as our multidisciplinary program in managing patient care.

With this level of expertise, you will receive the treatment that specifically targets your lung cancer sub-type. We’ll stay with you every step of the way, making sure you’re getting excellent care.

Take heart that, when your cancer is caught at an early stage, you stand a very good chance of cure. The American Cancer Society reports that over 430,000 people alive today have been diagnosed with lung cancer at some point.

A Transplant’s Not the Only Alternative for Children With Intestinal Failure; Rehab is an Option for Most Patients

Mercer
DAVID F. MERCER, MD, PhD

Our intestinal transplant program has a worldwide reputation. We’ve performed more intestinal transplants here at The Nebraska Medical Center than any other single hospital in the world. We helped pioneer the procedure.

But whenever possible we prefer not to do it.

Rehab for our pediatric intestinal failure patients is so successful, we don’t need to transplant very often. Rehab has become our default – with transplant as a wonderful backup plan, but no longer the only option.

Our patients come from all over the country and around the world. Many times, parents have been told that an intestinal transplant is the only treatment for their child. But when they arrive, we start with what they have – whatever the child’s condition and function – and go from there. It’s better to build on whatever they have than to start over. The family goes from having no hope to realizing that, very likely, their child will be able to live and eat normally.

When a child comes to our program, the family needs to be here four to six weeks. That sounds like a long time at first. But once they arrive, the families are so relieved and comfortable, often they don’t want to leave. Regardless of when they return home, they are part of the program for life.

Here’s what usually happens. The first week is evaluation with testing every day, and we make a plan. Next is an inpatient stay for a surgical intervention. Then it’s outpatient care for the next few weeks, attending weekly clinics and communicating almost daily with our team as we work on improving function in the intestinal tract, finding a pathway that will work for them and carefully moving toward our goal of eating and drinking by mouth.

When I tell parents that we hope their baby will one day go to kindergarten, carry a lunchbox to school and eat just like other kids, it blows their minds. But that is the goal, and we see our patients reach it all the time. It takes time and a dedicated team of experts guiding the way, but we get there working together. The family has been told to expect the worst; we let them know to expect the best.

There are times when we meet a child and we decide that the risks of taking time to work on intestinal rehabilitation are too high – that perhaps there has been too much damage done prior to their arrival.  There are other times when, despite everything we do, we cannot make progress and the risks of being on TPN begin to mount. These are the times when we turn to transplant, and in these cases it is truly lifesaving.

Rehabilitation and transplantation aren’t competitors with each other, but rather they work together so the right thing can be done for a child at the right time. When we can, we always prefer rehab, because successful intestinal rehabilitation doesn’t just delay the need for a transplant – it eliminates it.  When that goal can’t be achieved, transplant moves in to provide lifesaving therapy.

With these two complementary tools, the child with intestinal failure has a great chance to live a full, productive life.

NICU Team Saves Baby Diagnosed With Rare Condition

Genevieve was born with a rare condition called congenital chylothorax. She was hydroptic, collecting fluid in her body tissues and around her lungs.

genevieve-wright

Genevieve was born with a rare condition called congenital chylothorax.

“The miracle on 42nd Street,” is how Genevieve Wright’s family describes their strong, resilient little girl.

On February 19th, Genevieve was born at Nebraska Medicine – Nebraska Medical Center with a rare condition called severe congenital chylothorax. She was hydroptic, collecting fluid in her body tissues and around her lungs. Only two percent of babies born with this condition survive. Most die inside the womb, or moments after birth.

“We’ve done a lot of crying and praying,” says Genevieve’s mom, Shelly Wright. “Genevieve has been in the fight of her life.”

shelly-genevieve

Shelly Wright enjoys cuddling with her 2-month-old daughter, Genevieve.

Over the last two months, Ann Anderson-Berry, MD, medical director of the NICU, inserted 14 chest tubes to drain the fluids from Genevieve’s body. Some days, the NICU team removed three cups of fluid. They also worked to replenish blood and electrolytes that Genevieve was losing. Dr. Anderson-Berry says, Genevieve’s case is unlike any other documented. There were no case reports that outlined a successful treatment plan. Most days, the NICU team wasn’t sure she’d survive.

“It’s been minute to minute,” says Dr. Anderson-Berry. “But, if you look at her now, you’d never know she was so critical. Genevieve is writing her own story.”

anderson-berry

Dr. Ann Anderson-Berry, medical director of the NICU at Nebraska Medicine, speaks with local reporters about Genevieve’s condition.

This week, Genevieve will likely be discharged and go home to join her parents and three siblings in Lincoln, Neb. She’s off the ventilator and respiratory support. She’s acting like a normal newborn, smacking her lips, smiling and scanning the room with her eyes.

“I feel like all I do is stare at her,” says Wright. “Where there’s life, there’s hope. This medical team really gave it their all. You gotta give them a chance, even the two percenters.”

Collaboration impacts personalized cancer treatment

Babu0114
Babu Guda, Ph.D., associate professor and director of the Bioinformatics Systems Biology Core Facility at UNMC

The Fred & Pamela Buffett Cancer Center has partnered with IBM to conduct early testing and feedback for IBM’s Watson Genomic Analytics program.

The IBM program in minutes identifies relevant mutations and potential drugs that may be considered in a treatment regime — all based on the patient’s genomic profile and the specific mutations.

The Fred & Pamela Buffett Cancer Center at UNMC and Nebraska Medicine in Omaha, is one of 14 leading cancer institutes to partner on the project, which is part of IBM’s broader Watson Health initiative to advance patient-centered care and improve health while building on IBM research advancements.

Most of the 1.6 million Americans who are diagnosed with cancer each year receive standard treatment. When standard treatment fails and with genetic sequencing becoming increasingly accessible and affordable, some patients are beginning to benefit from treatments that target their specific cancer-causing genetic mutations.

Babu Guda, Ph.D., associate professor and director of the Bioinformatics Systems Biology Core Facility at UNMC, will be collaborating with Ken Cowan, M.D., Ph.D., director of the Fred & Pamela Buffett Cancer Center and breast cancer physician, to analyze cancer tumor genomes on the project.

“IBM has fed millions of research articles into the program, including biomedical research and clinical information,” Dr. Guda said. “The cognitive computer can keep track of the complex relationships among gene mutations, drug treatments and treatment outcomes.”

IBM describes cognitive computing as computers that learn and interact naturally with people to extend what either humans or machines could do on their own to help human experts make better decisions.

With each patient, the cancer center team is sequencing the genomes of normal and tumor tissues and identifying variations that are specific to the tumor tissues. Tumors can have many mutations, but some — “driver mutations” — are critical for the initiation and progression of cancer.

“Typically, we get several thousands (of variations),” Dr. Guda said. “Not every change is important, but some driver mutations or other serious mutations that alter cellular function may give a selective advantage for cancer cells to proliferate and spread the disease to distant locations,” he said.

Steve Harvey, vice president, IBM Watson Health, said Watson will help deliver personalized cancer care using the latest advances in science by integrating complex and disparate data in a cognitive system. “Ultimately, our goal is to create a solution that any oncologist in any location can use to identify personalized treatment options for their patients.”

Loading