Dr. Hank Kaplan remembers a time in the mid-1970s when neither cancer patients nor their caregivers had many treatment options. As a recent medical school graduate, Kaplan visited a cancer physician’s office, where after a brief discussion about the patient’s tumor, the doctor would inject every patient with the same chemotherapy. Kaplan asked why every patient—no matter the cancer type, location, or tumor size—would receive the injection.
“That’s all we have for solid cancers” was the physician’s response. The injections’ success rate was only 10%-15% and could only keep cancer at bay for a limited time. Chemotherapy was a tool often added to surgery but it came with serious side effects, and was one-size-fits-all for most cancers.
Now, Kaplan will lead the Initiative for Molecular and Genomic Evaluation of Cancer at the new Paul G. Allen Research Center at Swedish Cancer Institute. After much deliberation and planning, Swedish leveraged a $20 million personal bequest from the late philanthropist and co-founder of Microsoft, Paul G. Allen, to establish the center. The gift, made shortly after his death in 2018, supports leading-edge research to better understand, treat and ultimately prevent cancer.
“Making discoveries in cancer care allows us to impact an enormous number of patients,” says Dr. Sara Jo Grethlein, executive medical director and medical oncologist at Swedish Cancer Institute. “Ideally, we’ll be put out of business by preventing cancer from occurring and improving outcomes for patients who do develop cancers by finding them at an early and highly treatable stage.”
In Kaplan’s lifetime, there’s been a dizzying transformation of the cancer field regarding prevention, diagnosis and treatment. In the early 1990s, National Cancer Institute researchers first discovered that a gene mutation could lead to kidney tumors. Findings like this highlight the realization that specific gene mutations may cause cancer.
Since then, we’ve also learned that 5%-10% of breast cancer is hereditary and caused by a mutated gene inherited from your mother or father. For example, when working normally, the BRCA1 and BRCA2 genes help your body suppress tumors. A BRCA gene’s mutation increases a person’s risk for breast, ovarian and other cancers. Women with a family history of breast, ovarian, tubal or peritoneal cancer can work with genetic counselors to determine whether they’re carriers of the BRCA gene and at higher risk of these cancers. Women can even take a direct-to-consumer test using a blood or saliva sample—no biopsies required.
Bringing diagnosis, treatment and prevention together
Researchers are currently making strides in cancer treatment by applying recent advances in computer technology, genetic testing and pharmaceutical therapies. Kaplan has been part of that knowledge revolution as a breast cancer physician and senior researcher at the Swedish Cancer Institute (SCI).
In 1990, the Swedish Breast Cancer Registry, a database containing the clinical information for thousands of breast cancer patients, including personal demographics, surgeries, treatments and genetic mutations found in either the patient or the tumor, was created. Physician researchers like Kaplan collect and analyze clinical, genetic and molecular data to reveal patterns in how cancers evolve and respond to treatment. The Initiative for Molecular and Genomic Evaluation of Cancer, which will study the genomic and metabolic evolution of cancer, is just one of the “pillars,” or centers-within-a-center at the Paul G. Allen Research Center at Swedish Cancer Institute. In addition, the Center for Immuno-Oncology, led by Dr. Kelly Paulson, will develop therapies using the patient’s own immune system to treat cancer. Finally, the Initiative for Cancer Prevention and Early Detection, under the direction of Dr. Chuck Drescher, will innovate methods for early cancer detection. For example, creating new screenings for currently unscreened cancers and examining genetics and cancer risk long before cancer presents.
As an example of how all three of these programs can come together, Kaplan relates the story of a patient dying from breast cancer. The patient’s cancer hadn’t responded to standard treatments. Then, Kaplan noted the presence of a rare mutation of a gene that might mean the cancer would respond well to a specific immunotherapy medication. After only four doses of the drug, her cancer disappeared.
Afterward, Swedish tested the patient’s adult children and found that they had the same gene mutation, one that could potentially cause Lynch syndrome. This is a syndrome that puts patients at risk for a number of different cancers. Armed with this now-multigenerational information, her children can take preventive action, look for any tailored treatments, or take advantage of advances in early diagnostic tools, which SCI is also working on.
“We want to tailor the cancer experience for every patient by matching the aggressiveness of intervention to the aggressiveness of the cancer,” Grethlein says. As another example, she notes that when lung cancer is found early in some patients, a genetic profile can be run on the tumor. The results can distinguish patients requiring chemotherapy from patients likely to avoid recurrence without chemotherapy.
SCI is also striving to recruit patients from diverse demographics and communities often underrepresented in genetic data sets, including people of color and rural residents. “We’re caring for all patients, not one demographic subset,” Grethlein says.
“We’re doing so much better than we were 15-20 years ago. It blows my mind,” Kaplan says. Ten years from now, you can’t even imagine how we’ll be treating cancer. There’s hope for people we can cure now who we couldn’t cure 10 years ago. In 10 years, we’ll cure people who aren’t cured today.”
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