Prostate Cancer Symptoms Tips What is prostate cancer symptoms? We have tips about prostate cancer symptoms

Join the second annual Penn Club of New York Spinathon Wednesday, April 18 from 7 am to 7 pm in support of the Abramson Cancer Center and its patients and families. This year, there will be two Spinning locations available.

This fun and healthy event benefits the LIVESTRONG™ Survivorship Center of Excellence at Penn’s Abramson Cancer Center. The goal is to have at least one Spin bike going the entire day in support of the cancer center, and those affected by cancer.

All are welcome – you do not need to be a Penn Club member to participate. The Penn Club of NY will also have silent auction items to bid on including a LIVESTRONG™ Trek Bike and Penn Medicine LIVESTRONG™ Challenge jerseys.

To reserve your time block (in 30 minute blocks) contact:

• Penn Club Fitness Center - 212.403.6623 or email at healthclub@pennclubny.org
• PedalNYC - 212.561.5435 or email Ride@PedalNYC.com

For more information, visit http://www.pennclub.org/spinathon

Make a gift online (gifts should be made in honor of Penn Club Spin-a-thon), or mail in a gift using this form.

This season is a time to celebrate the holidays with family and friends while reflecting on the wonderful things and people surrounding you. It’s also a time to share holiday hope with cancer patients and their families.

Penn’s Abramson Cancer Center provides this hope throughout the year. During a time of ever-decreasing charitable giving, a gift to the Abramson Cancer Center Annual Fund provides essential funding for current and new programs for cancer patients and their families.

Just like every patient is different, every gift the Abramson Cancer Center receives is special and very important. Each gift provides the Abramson Cancer Center with the necessary resources to provide cutting-edge research and the best in cancer care to patients and their families in the Philadelphia region.

Charitable giving to the cancer center’s annual fund is essential in the fight against cancer. Individually, each person can make a difference; collectively, the many friends of the Abramson Cancer Center can shape the future of cancer research and patient care.

Make a gift to the Abramson Cancer Center this holiday season and spread the holiday annual giving cheer.

Ways to give to the Abramson Cancer Center Annual Fund

Online
Make an online gift on the cancer center’s secure giving site.


By mail
Print and fill out a gift form and mail your gift to the Office of Development and Alumni Relations, where your gift will be processed quickly and securely:


Thanks to you, the Abramson Cancer Center continues to achieve victories in the ongoing effort to conquer cancer.

Everyone at the Abramson Cancer Center thanks you for your generosity during the holiday season, and throughout the entire year.

To learn more about giving to Penn’s Abramson Cancer Center visit the website at www.PennMedicine.org/Abramson/Donatehttp://www.penncancer.org/patients/giving/


Please make a tax deductable gift before December 31 and spread the holiday annual giving cheer.

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the last of four posts about the latest findings in treating breast cancer.

More News on Aromatase Inhibitors (AIs)
A group of bone health-related studies (Abstracts 516, 517, 518) presented at the 2011 ASCO conference provided some good news on bone loss. The studies showed that postmenopausal breast cancer patients undergoing endocrine therapy (aromatase inhibitors) do not experience an increase in their total number of fractures, despite having some level of bone loss.

Over a period of approximately six years, 5 percent of patients receiving aromatase inhibitors (AIs) suffered fragility fractures, the same percentage as occurred in the control group. Studies also show that exemestane may result in less bone loss than other AIs.

A third set of AI studies (Abstracts 522,523 525) strengthened the data supporting the proposition that women who experience endocrine-related symptoms, specifically arthralgia and bone pain, while taking AIs do have improved treatment efficacy.

Regional vs. Whole Breast Irradiation for Node-Positive Cancer
The controversy regarding the optimal treatment approach for breast cancer with one to three positive nodes has existed for some time. Current treatment guidelines call for regional lymph node irradiation (RNI) for all patients with four or more positive nodes, but have been less clear about the role of RNI in cases involving one to three nodes.

Another trial highlighted at the ACO conference, NCIC-CTG MA.20, bolsters the view that all node-positive breast cancer patients should be considered for RNI.

In this large, intergroup trial, women with positive nodes or high-risk node negative breast cancer were treated with breast-conserving surgery. They were then randomized to receive either standard whole breast irradiation (WBI) or WBI plus RNI. The study demonstrated a clear advantage for the WBI plus RNI group for five year overall and disease-free survival. They did experience modestly increased toxicity, mostly attributable to a slight increase in grade II lymphedema.

Focus on Neoadjuvant Therapy for HER2-Positive Breast Cancer
Neoadjuvant therapy, or therapy that is given before primary cancer treatment, is becoming a standard way to study new approaches to treating breast cancer. Angela DiMichele, MD, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, noted the emphasis on neoadjuvant therapy at the ASCO meeting, citing several studies for women with HER2-positive breast cancer, a group for which there is a growing number of treatment options.

The first (abstracts 505, 507) combined lapatinib and trastuzamab in a neoadjuvant setting without chemotherapy for women with HER2-postive tumors >3cms or >2cms with palpable nodes. The results were positive with an overall pCR of 28 percent and a 40 percent pCR in ER- negative patients and strengthened the evidence for the dual receptor blockade as the new standard of therapy for HER2-positive tumors. The study did have an 8 percent drop out rate resulting from toxicity, primarily diarrhea and acne form rash.

The other studies (abstracts 531, 532) looked at the results of adding chemotherapy to the dual receptor blockade. The first demonstrated a clear advantage to lapatinib and trastuzamab with anthracycline-taxane therapy in terms of pCR, but left unanswered issues as to whether the increased toxicity with chemotherapy is worth the risk and whether the pCR will translate into long-term survival.

Triple-Negative Breast Cancer
While the options for HER2-postive patients continue to expand and improve, the need remains to discover more effective therapies for the 15 percent of patients diagnosed with triple negative breast cancer (TNBC). While considerable attention was focused on TNBC at ASCO 2011, the meeting did not yield significant progress for women with this disease.

Several trials offered data suggesting that basal subtypes of breast cancer might be sensitive to platinum, but much more information is needed to clarify which subgroups of patients and under which circumstances will benefit from this therapy (Abstract 1015). Similar issues apply to the use of agents targeted to the mTOR and PI3K pathways (abstract 1016). The conclusion: For TNBC, a commitment to larger, well-designed trials with integrated, adequately-powered biomarker assessment are needed.

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the third of four posts about the latest findings in treating breast cancer.

BMI and Cancer Outcomes
In recent years, the belief that obese breast cancer patients have worse outcomes has become somewhat entrenched in the cancer community. A North American Breast Cancer Group study presented in 2010 appeared to be confirmed those findings. But just one year later, data presented at ASCO 2011 data (abstracts 513, 514, 515), appears to contradict that belief.

Angela DeMichele, MD, associate professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, said the combined analysis of five National Cancer Institute studies demonstrate no compelling evidence that obesity, a body mass index (BMI) of 30 or more, compromises breast cancer survival. The studies also show BMI does not affect estrone (the estrogen left after menopause, made primarily by body fat) levels in postmenopausal women.

Despite the discrepancy in the findings, Dr. DeMichele reinforced the need to encourage obese women to lose weight and provide active support to women undergoing hormonal treatment to help them avoid weight gain.

Exemestane Yields Impressive Results in Prevention Study
One of the most noted studies at this year's ASCO meeting was the MAP3 trial (abstract 504), which presented persuasive evidence that the aromatase inhibitor exemestane, has a significant effect in preventing invasive breast cancer in medium to high risk postmenopausal women. The study, released simultaneously in the New England Journal of Medicine, represents a "huge victory for chemoprevention," in the words of the Angela Bradbury, MD, who presented the study at the ASCO meeting.

In this large, multinational study, women who received exemestane had a 65 percent reduction in invasive breast cancer. This is a superior result to the 50 percent reduction seen in studies utilizing tamoxifen and raloxifen.

Over a three-year period, exemestane reduced the incidence of ductal carcinoma in situ and other precancerous conditions, and appeared to reduce the incidence of more aggressive breast cancers in those women who did develop the disease. In addition, the study found that the side effects; hot flashes, insomnia, and arthralgia; were not excessive and generally well tolerated by the study participants. Serious toxicities including fractures, other cancer, osteoporosis and cardiovascular events were not seen in the study participants.

While the MAP3 results are without question important and exciting, some experts question whether healthy women will take a drug that is associated with a spectrum of menopausal type symptoms, even to achieve an important goal of reducing invasive breast cancer. The answer may depend on a variety of factors including:

• Level of individual risk
• Age
• Overall health
• Conversations between women and their doctors as they become aware of this new study and its implications for preventing the second leading cause of cancer deaths in women

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Coming up next, The Value of Adjuvant and Neoadjuvant Therapy.

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the second of four posts about the latest findings in treating breast cancer. 

One of the larger trends in cancer treatment, especially breast cancer treatment, is the increasing ability to identify biologic subtypes of the disease and the need for better prognostic biomarkers, or biomarkers that provide information regarding outcome without regard for therapy.

Angela DeMichele, MD, MSCE

At the 2011 ASCO conference, Angela DiMichele, MD, MSCE, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, talked about the important role biology plays in identifying these markers. As co-program leader of the Abramson Cancer Center's National Cancer Institute (NCI)-approved breast cancer program, she discussed one such marker, Ki-67, and intrinsic genetic subtypes.

Two studies (Abstracts 500 and 501) provide support for the validity of Ki-67 as a means of identifying highly proliferative tumors and those that are more likely to respond to specific chemotherapy regimens. Ki-67 is a cancer antigen that is found in growing, dividing cells but is absent in the resting phase of cell growth. This characteristic makes Ki-67 a good tumor marker. This test is done on a sample of tumor tissue, to help predict your prognosis.

Many studies have been done to determine Ki-67's value as a tumor marker test. Researchers agree that high levels of Ki-67 indicate an aggressive tumor and predict a poor prognosis and tumors that tested positive with high levels of Ki-67, have a higher risk of recurrence.

Perhaps more intriguing is the emergence of intrinsic subtypes of breast cancer. Gene expression studies have identified several distinct breast cancer subtypes. The value of this information is less clear, but understanding the specific biologic characteristics that influence these subtypes may help determine which patients will respond to which therapies.

Cancer researchers now understand that breast cancer is a spectrum of diseases, ranging from those that are more endocrine driven to those that are more chemosensitive. These findings reinforce the need for accurate molecular profiling for all breast cancer patients.

OncotypeDX has become a standard means for molecular profiling and guiding breast cancer treatment decisions, but another, potentially even more comprehensive tool is on the horizon. PAM-50 screens for 50 genes and is potentially more sensitive, but is not yet clinically available. Further studies are needed to validate its use.

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Coming up next, How Weight and Hormones Affect Breast Cancer Outcomes.

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the first of four posts about the latest findings in treating breast cancer.

The summary of the latest news in breast cancer treatment was delivered in rapid-fire style at the Abramson Cancer Center’s 2011 Update in Breast Cancer ASCO summary course. Unfortunately, many of those attending the annual conference thought the news was "not as exciting as last year," because of the lack of any single, major breakthrough.

At the 2010 conference, Penn cancer researchers highlighted the promising results of targeted immunotherapy in treating metastatic breast cancer.

While there may have been no single big story, significant data were presented across the full platform of breast cancer-related topics: from prevention to neoadjuvant therapy and managing metastatic disease. Major emphasis was placed on improved understanding of the biology of breast cancer and the development of more targeted therapies tailored to match the specific genetic profiles of patients.

From the Headlines: FDA Approval for Bevacizumab

David M. Mintzer, MD

One issue that has been in the headlines during the past months is the status of FDA approval of bevacizumab (Avastin®) for first-line of treatment of HER2-negative metastatic breast cancer in combination with paclitaxel.  Bevacuzumab received fast track approval in 2008. Subsequent studies, including those presented at ASCO 2011, demonstrated modest improvements in progression-free survival, but none in overall survival or improvement in disease-related symptoms.  The down sides of the drug are its toxicity and high costs of administration.

Just hours after the update concluded, the Oncologic Drugs Advisory Committee voted 6-0 to withdraw FDA approval for bevacizumab for treating HER2-negative metastatic breast cancer. While the committee vote was unanimous, the hearing itself was marked by emotional pleas from breast cancer patients who believe they are benefitting from bevacizumab treatment.   The recommendation is not binding and a final decision is expected in September. It also does not affect insurance coverage or availability at this time, or the drug's approval for other cancer types.

"We know this drug has activity in some women," said David Mintzer, MD, clinical associate professor and chief of hematology/oncology, Pennsylvania Hospital. "We have all seen it and we know that activity stops when you stop giving the drug, but we just know now how to predict which women will get that benefit."

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer 

Coming up next, Understanding the Biology of Breast Cancer.

Bruce Levine, PhD, research associate professor at the Perelman School of Medicine, and facility director, Clinical Cell and Vaccine Production Facility at Penn's Abramson Cancer Center, shares some of the response to the findings of "serial killer" T cells to treat cancer.

Our recent breakthrough in using genetically modified T cells to destroy cancer cells announced continues to draw attention nationally and around the world.

Genetically modified T cells

The research, published simultaneously in the New England Journal of Medicine (NEJM) and Science Translational Medicine in August, is the first demonstration of the use of gene transfer therapy to create "serial killer" T cells aimed at cancerous tumors. The study shows sustained remissions of up to a year among a small group of patients with advanced chronic lymphocytic leukemia (CLL) treated with genetically engineered versions of their own T cells.

Each of our recent reports were selected and evaluated by the Faculty of 1000 (F1000). F1000 identifies and evaluates the most important articles in biology and medical research publications. Articles are selected by a peer-nominated global 'faculty' of the world's leading scientists and clinicians who then rate them and explain their importance.  On average, 1,500 new evaluations are published each month; representing approximately 2 percent of all published articles in the biological and medical sciences.

The comments from the F1000 evaluators follow. While the evaluations highlight the technical research, both evaluations rated the study as "exceptional."

Chimeric antigen receptor-modified T cells in chronic lymphoid leukemia. (N Engl J Med 2011 Aug 10), evaluated by Christopher Thanos.
Evaluation details: Exceptional [10] New Finding, Technique

Review: This exceptional article investigated a possible avenue for the treatment of chronic lymphoid leukemia (CLL). The authors used a lentivirus system to infect harvested T cells with a vector that expresses a chimeric protein consisting of an extracellular, anti-CD19 scFv fused to intracellular CD137 and CD3 signalling domains. T cells expressing this chimeric anti-CD19-CD137-CD3 fusion protein were then administered back to a CLL patient and the results were profound. There was massive proliferation of these engineered T cells (>1000X) after administration to the patient, and, by day 23, there was no evidence of CLL in the patient's bone marrow (complete remission).

T cells with chimeric antigen receptors have potent antitumor effects and can establish memory in  patients with advanced leukemia. (Sci Transl Med 2011 Aug 10), evaluated by Joyce Solheim.
Evaluation details: Exceptional [10] Clinical Trial

Review: This article expands on exciting new developments in the use of genetically modified T cells expressing antibody-binding domains as therapies against malignancies. As an accompaniment to their recent case report in the New England Journal of Medicine on the amazing impact of T cells expressing a CD19-specific chimeric antigen receptor, the authors have here provided a more detailed analysis. In this article, they describe the expansion and trafficking of the T cells that they have used to target chronic lymphocytic leukemia, and they delineate the immune responses (including the establishment of T cell memory and prolonged effector function). The clinical effects noted by the authors were impressive in all three patients, although the side effects observed were also quite significant. The specific strategies used by these investigators in their production of the modified T cells have yielded new clues about how complex immune responses in humans can be driven, and have surely laid the groundwork for many future clinical trials, particularly for B cell malignancies.

Senior author of the NEJM paper is Carl June, MD, director of translational research and professor of pathology and laboratory medicine at the Abramson Cancer Center, who led the work. Co-principal investigator is David Porter, MD, professor of medicine and director of Blood and Marrow Transplantation. Co-authors include Bruce Levine, PhD; Michael Kalos, PhD, and Adam Bagg, MD; all from Penn Medicine.

Drs. Kalos and Levine are co-first authors on the Science Translational Medicine paper. Other co-authors include Drs. June, Porter and Bagg and Sharyn Katz, MD, from Penn and Stephan Grupp, MD, PhD, Children's Hospital of Philadelphia.

Neha Vapiwala, MD, chief of the genitourinary service for Penn Radiation Oncology, discusses proton therapy for prostate cancer, available at Penn Medicine.

Proton therapy, available at Penn’s Roberts Proton Therapy Center, is an incredible new way to deliver targeted radiation therapy to many types of tumors, including prostate cancer.  Penn Medicine recently celebrated the second anniversary of the proton therapy center.

In this interview, Dr. Vapiwala discusses how specialists throughout Penn Medicine and Penn's Abramson Cancer Center, an NCI-designated comprehensive cancer center, collaborate on developing innovative ways to enhance the prevention, diagnosis and treatment of genitourinary cancer through research and patient care.







Learn more about proton therapy at Penn Medicine

• Watch a patient talk about his experience with proton therapy for prostate cancer at Penn Medicine. 
• Learn more about proton therapy for prostate cancer.
• Watch a webcast about proton therapy for prostate cancer.

David C. Metz, MD

 
That is why it is my absolute pleasure to inform you of Penn Medicine’s Neuroendocrine Tumor (NET) Symposium, a CME-certified course*, scheduled for Friday, Sept. 9 on the Penn campus. 

Penn Medicine’s NET program has been designed to provide excellent state-of-the-art diagnosis and management of patients with gastrointestinal NETs, including alimentary tract carcinoids or pancreatic NETs, as well as pheochromocytomas and paragangliomas.

• Arise in multiple different primary sites.
• Be functional or non functional (functional syndromes also vary significantly between patients).
• Have variable biological behavior which is difficult to predict.

Many tumors also arise as a component of an inherited syndrome such as MEN-1 or 2 or one of the phacomatoses (neurocutaneous syndromes).  The management of localized disease is primarily surgical, but commonly patients present with metastases requiring a multidisciplinary approach for effective long-term management.

This CME course has been designed to demonstrate the broad expertise available at Penn Medicine as well as to provide in-depth lectures on all the various disciplines involved in the management of NET patients.   This will be an excellent learning experience for physicians, extenders, nurses and trainees.  We hope to provide a general algorithm for the management of these often complex and difficult to treat and diagnosis patients.  Hopefully, you will be able to join us.

Where: Biomedical Research Building II/III, 421 Curie Boulevard, Philadelphia, PA


* Accreditation:  The Perelman School of Medicine at the University of Pennsylvania is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.