UNMC and The Nebraska Medical Center’s cancer and solid organ transplantation programs attract patients from all over the world. Its health professionals are well-known for their excellence and get invited to share their expertise all over the world.
The clinical cancer program at UNMC and The Nebraska Medical Center is recognized as one the most successful and better known centers in the world, particularly for its expertise in leukemias and lymphomas. About half the clinical and basic research grants awarded to UNMC are cancer-related.
The team performs more transplants for lymphoma than most institutions in the world. Health professionals are involved in participating in clinical studies that improve cancer treatment and care.
Sharing knowledge at NCCN
This past week, a group of health care professionals and support staff from UNMC and The Nebraska Medical Center joined about 900 others from around the world at the National Comprehensive Cancer Network’s (NCCN) March 10-14 conference in Florida.
The 9th Annual Conference: Clinical Practice Guidelines & Outcomes Data in Oncology included some of the latest clinical practice guidelines and updates on new cancer therapies and emerging issues in oncology business management.
The impact of the NCCN’s 19 member organizations, which includes UNMC, is far-reaching. The not-for-profit alliance of the world’s leading cancer centers supports and strengthens the mission of member institutions in providing state-of-the-art cancer care; advancing the state of the art in cancer prevention, screening, diagnosis and treatment through research; and enhancing the effectiveness and efficiency of cancer care delivery through the ongoing collection, synthesis and analysis of outcomes data.
Two UNMC faculty members presented at the conference: Alison Freifeld, M.D., associate professor of internal medicine and director of the UNMC Immunocompromised Host Infectious Diseases Program, and James Armitage, M.D., Joe Shapiro Professor of Medicine and UNMC oncologist.
Preventing, treating fever and neutropenia
On March 13, Dr. Freifeld shared new ways of preventing and treating fever and neutropenia that occur in some cancer patients. She has served on the NCCN Fever and Neutropenia Committee for several years and recently was appointed as chair of the committee.
Fever and neutropenia are common consequences of chemotherapy for cancer treatment and/or preparation for a stem cell transplant. When neutrophils — white blood cells — go below a certain level, the risk of infection rises dramatically. “We as health care professionals are very vigilant about any sign of infection, particularly fever, in patients whose white blood cells are suppressed after cancer therapy” Dr. Freifeld said.
Protecting from possible infections
It is standard for anyone with a fever and neutropenia to be admitted to the hospital to receive intravenous antibiotics to protect them from possibly serious infections.
During her talk, she addressed how to define low-risk and high-risk patients with fever and neutropenia and outlined new ways of managing those who are in the low-risk category.
“Oncology physicians now are in a position to make decisions about who to send home with oral antibiotics, versus who with fever and neutropenia should be kept in the hospital to receive intravenous antibiotics,” Dr. Freifeld said. “This is a great advance for patients who can still be treated for possible infections safely and efficiently outside the hospital setting.”
Update on fungal infections
During the conference, Dr. Freifeld discussed new drugs and developments, including detection and treatment of fungal infections. She said a select group of transplant patients get severe fungal infections — primarily patients who have leukemia, acute leukemia, and those who are undergoing allogeneic stem cell transplants.
“We see a fair number of these patients at UNMC, so this is pertinent to our center and other NCCN centers. The NCCN meeting is a perfect forum for us to discuss what’s new in fungal treatment and diagnosis,” she said.
“A number of new, potent anti-fungal drugs have become available in the last year or two. One of these has quickly become a new standard for the treatment of devastating invasive mold infections, particularly in allogeneic transplant patients and leukemic patients. It’s a very tough problem and we now have a new drug that has yielded better survival than our previous treatments. The nice thing about this drug is that it comes in an oral form, so again, patients can take it as outpatients.”
Managing infections
Dr. Freifeld, an infectious disease specialist, provides advice for cancer and solid organ transplant patients with infections. She estimates about 10 percent to 20 percent of certain cancer transplant patients get life-threatening infections. In the 1960s and 1970s, when cancer chemotherapy was being developed, the death rates for infection could be as high as 80 percent but now, advances have decreased that rate to less than 5 percent, Dr. Freifeld said.
Bacteria that live naturally in the body or environment don’t normally pose a health problem, but to transplant patients who are immunosuppressed, or are more susceptible to getting infections, common bacteria pose a significant health threat.
Improving cancer treatment, care
About five years ago, Dr. Freifeld, who’s had a longtime research interest in treating infections in cancer patients, helped make it possible for certain cancer patients with fever and neutropenia to be treated at home instead of in the hospital. She and colleagues at the National Cancer Institute in Bethesda, Md., conducted a large research study that demonstrated that oral antibiotics were equally as effective as intravenous antibiotics for a selected group of patients with fever and neutropenia. The article describing the work appeared in the New England Journal of Medicine in 1999.
UNMC faculty will continue to work to improve cancer treatment and care, Dr. Freifeld said. “I think one of the unique things about UNMC is that we have such incredible strength in both oncology transplantation and solid organ transplantation. That’s a rare combination. Most centers have strength in one or the other. Our center clinically has a national reputation in both areas.”
Success of radioimmunotherapy
Dr. Armitage’s talk focused on the success of radioimmunotherapy, a relatively new form of treatment for certain kinds of non-Hodgkin’s lymphoma. Dr. Armitage, an internationally recognized expert in the research and treatment of lymphoma, started the bone marrow transplant program at UNMC in 1982. The program since has evolved into one of the best in the country, performing more transplants for lymphoma than most institutions in the world.
Radioimmunotherapy combines two types of therapies – radiation therapy and immune therapy using monoclonal antibodies. Dr. Armitage said radioimmunotherapy is important because some patients, particularly with CD20 positive, follicular, non-Hodgkin’s lymphoma, don’t respond to other therapies, but do respond to radioimmunotherapy.
“Radioimmunotherapy is a relatively new therapy within the last several years that is extremely active because it allows you to deliver radiation directly to the tumor, so the radiation isn’t given to all of you, just in the areas of the tumors,” he said.
New drugs offer treatment
Two new drugs, Bexxar® and Zevalin®, are used as radioimmunotherapy treatment. They carry radioactive substances to the antigen on the cancer cell. According to the Leukemia & Lymphoma Society, monoclonal antibodies can also be linked to a radioactive isotope to target and kill specific cancer cells. The antibodies are injected into the patient in the hope that the antibodies latch on to the antigen on the cancer cells and destroy them.
The drugs, developed in the 1990s, were studied at multiple centers, including UNMC, before they were approved. UNMC’s Julie Vose, M.D., was principal investigator for six studies. The U.S. Food and Drug Administration approved Zevalin in 2002 and Bexxar in 2003.
Learn more
To learn more about cancer or get free cancer treatment guides, go to the NCCN’s Web site or call the NCCN toll-free at 1-888-909-NCCN. Materials also are available on the American Cancer Society’s Web site or by calling 1-800-ACS-2345.