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On the Horizon!!!!!


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Treatments on the horizon

Promising proton therapy

The Roberts Proton Therapy Center at Penn, the world's largest cancer cyclotron, opens this fall. Unlike conventional radiation, protons can be made to deposit their energy only when they reach a target. Proton therapy can reach tumors deep within the body while minimizing damage to surrounding tissues, so it is favored for treating optical nerves, the spinal cord, head and neck areas, the prostate and pediatric patients.

Extra-precise cyberknife

Fox Chase Cancer Center's first community radiation-oncology facility, opening in July in Buckingham Township, Bucks County, will have a "cyberknife" - a linear accelerator with robotic controls that can change positions while the patient stays still. It is designed to enable ultraprecise targeting of radiation to hard-to-reach brain, lung and spine tumors.

Less-is-more surgery

Since the 1980s, many surgeries that once required opening large sections of the body have been done "laparoscopically" - through several small incisions, using scopes and long, flexible instruments. The instruments may be held by a "robot" that the doctor controls remotely. This shift is changing cancer diagnostics, staging and treatment by reducing trauma and speeding recovery. Recently, Fox Chase surgeons used a new robot-assisted laparoscope to remove a suspected cancerous cyst from the pancreas of a 65-year-old, and Thomas Jefferson University Hospital used a robotic system to remove a patient's esophagus.

See-through technology

Cutting out a tissue sample to analyze it for cancer is a time-consuming, expensive and invasive process that may miss the cells of interest. A wave of innovations is reducing the need for surgical biopsy.

Among them: Optical coherence tomography, which uses infrared light to create images much the way ultrasound uses sound waves for imaging, is being developed to diagnose lung and colon cancer. Laser scanning combined with microscope technology is being used for skin-cancer detection.

Drexel University microbiologists are working with the National Cancer Institute and the Hepatitis B Foundation to develop an antibody test for liver scarring, which can progress to cirrhosis and cancer.

Better genetic profiles

Companies are racing to develop molecular tests that reveal which genes are turned on in different types of cancerous tissue.

These "gene-expression profiles" can be used to diagnose disease, predict progression and eventually even foretell how patients will respond to drugs and radiation. MammaPrint and Onco-type DX are being used to predict the risk of breast-cancer recurrence, and tests for colon and prostate cancer have come on the market. The caveat is that the predictions are sometimes wrong or ambiguous, and Food and Drug Administration regulation so far is minimal.

Tailored treatments

Tests for individual gene mutations are being used to tailor drug-treatment decisions by revealing which patients are likely to suffer toxicity, and which won't respond at all.

Among FDA-cleared tests are ones that predict lung-cancer response to the drug cetuximab and colon-cancer response to the drugs irinotecan and cetuximab.

Given the extraordinarily high costs of newer cancer drugs, "pharmacogenomic" tests are seen as crucial to avoiding futile, wasteful treatment. The American Society of Clinical Oncology recently recommended the cetuximab response test.

Therapeutic cancer vaccines

While conventional vaccines prime the immune system to recognize an infectious invader, cancer vaccines aim to trick the immune system into attacking the body's own cells after they turn malignant. Although the field has been frustrated by drug-development setbacks, research is racing ahead. Penn researchers, for example, have reported early success in boosting the body's natural immune response to ovarian, breast and cervical cancers. The University of Pittsburgh is testing a vaccine that may prevent colon cancer in people at high risk for the disease.

Bone meds

Over the last decade, bisphosphonates, powerful bone-protecting medicines, have been used to reduce pain and fractures in myeloma, breast- and prostate-cancer patients with bone metastases. But it appears these drugs can also slow cancerous growth in bones, and maybe even prevent the spread to bones. Human trials are under way here and across the country.


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