Solving the Puzzle of Cancer Treatment
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Published on January 25, 2018

doctor holding puzzle pieces

Solving the Puzzle of Cancer Treatment

Cancer treatment is like a puzzle. As cancer grows and changes over time so do the types of treatment that work best. It’s your cancer team’s job to match the best treatment to your cancer at a certain snapshot in time.

That’s done in part by analyzing your DNA. But research is only just beginning to pinpoint which treatment therapies work best for each newly discovered mutation.

That is what the experts at Avera Cancer Institute's Precision Oncology Program and Avera Research Institute are focused on as they create the infrastructure to develop Phase 1 trials for patients.

In fact, scientists at Avera are researching drug combinations for specific cancer mutations that could one day become standard of care through clinical trials done right here at Avera.

"Infinite Combinations"

“There are infinite combinations of genetic changes that can occur with cancer but not an infinite number of drugs to treat it,” said Casey Williams, PharmD, part of the Precision Oncology team. “The only way to truly make a maximum impact in cancer is to combine new and existing therapies and limit the ability of cancer to grow and change.”

Genomic medicine helps guide care by sequencing the patient’s cancer DNA to determine the specific cancer mutations. This allows the Precision Oncology team to work with the rest of the patient’s care team to determine the best types of treatment.

“Research has allowed us to understand that tumors change over time and to match this growth to individual treatments,” said Richard Conklin, MD, oncologist and hematologist in Aberdeen, who has offered clinical trials to area patients for more than 20 years. “We also have leading experts in genomics and translational research to help us with more advanced therapies. Only a small percent of cancer centers in the country even have that capability.”

Innovating Our Own Path

To further that goal, Williams and the physicians of Avera Cancer Institute recently developed the first two investigator-initiated Phase 1 drug therapy trials at Avera. These trials were approved by the U.S. Food and Drug Administration and the respective pharmaceutical companies to move forward with patients to test the safety and efficacy of the new drug combinations.

This is in addition to the standard portfolio of clinical trials in which Avera participates but did not develop – some of which are early phase. Few health systems outside of the 69 National Cancer Institute designated cancer centers develop and/or participate in Phase 1 trials because of the lack of necessary infrastructure and expertise.

Williams and his colleagues are working with various types of cancers at all stages of treatment. Treatment becomes more complicated in later stages because the cancer has had more opportunity to grow and change. That’s why Avera research investigators are developing multi-drug combinations that can block multiple paths to limit growth of specific cancer mutations.

Building a Basket of Studies

The team will continue to develop and open Phase 1 trials at Avera to offer therapies not otherwise available to patients in our region or possibly anywhere. The more of these combinations that can be created and proven to be safe and effective, the more successfully cancer can be treated without recurrence.

“We’re building a basket of studies,” Williams said. “We want the oncologists to be able to order genomic sequencing, and then use that genomic information to decide whether that patient may benefit from any of the available studies and treatment regimens.”

Genomics and Risk

Long-term, Williams and his colleagues want to investigate ways to categorize genomic information from patients from high to low risk so patients can get the right level of treatment according to their needs.

It’s a change in focus from which drug works better – A or B – to a more patient-focused approach recognizing treatments aren’t one size fits all.

“Our goal is to reduce the toxicity for those who don’t need it and maximize therapy for those who do need it to avoid recurrence down the road,” Williams said.

Cancer Clinical Trials — Myths Debunked

MYTH: Clinical trials are only available for cancer treatment.

FACT: Clinical trials are available across the spectrum of cancer care – from prevention and screening to diagnosis and treatment.

For example, at Avera Cancer Institute you’ll find a wide variety of clinical trials for:

  • Cancer prevention
  • Cancer screening and diagnosis
  • Cancer-related symptoms and side effects
  • Treatment options

MYTH: When it comes to cancer treatment, clinical trials are only offered as a last alternative.

FACT: Clinical trials are available for all situations.

No matter what stage of cancer treatment you are in, clinical trials may offer more effective options for specific circumstances than the current standard of care provides. That’s why your Avera cancer care team will determine whether or not you may be eligible to participate in a clinical trial from the onset. If so, it’ll be included as one of your treatment options.

MYTH: I might only receive a placebo, or “sugar pill,” if I enroll in a clinical trial.

FACT: If you enroll in a cancer treatment clinical trial, you’ll always receive at least the gold standard of care. Any investigational drugs or placebos that are part of the study are added to the standard of care regimen – not as a replacement for the standard of care.

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