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The major focus of CORI’s research will be focused in gastrointestinal cancers (including colorectal, pancreas and liver), melanoma, breast cancer, and cancer related-imaging with the aim of developing new therapeutics.
GI cancers are the second most common cause of cancer-related deaths in the United States. In 2007, there were 271,250 GI cancers in the United States with 134,710 deaths. Additionally, colon cancer was the fourth most common cancer in California with 15,000 cases, and was second only to lung cancer with more than 5,000 deaths. While surgery remains the most effective treatment, few patients will be cured by surgery alone, due to the severity of the disease at the time of diagnosis.
Survival has been impacted by inadequate methods of early detection and more effective systemic therapies. Improving these statistics will require further research into methods of early cancer detection and the development of innovative therapies. The lack of research funding in GI cancers has had a devastating effect on those afflicted with these diseases, with the ratio of deaths to new cases remaining approximately 1 to 1.
As compared with other cancers, especially breast and prostate, GI cancer deaths continue to be unacceptably high. According to the American Cancer Society (ACS), the incidence of colon cancer cases in California is the highest in the nation. Thus, the ACS also reports that the state of California has the largest number of colon cancer deaths. However, in recent years, some progress has been made in creating a greater public awareness of colon cancer through education programs on screening. Unfortunately, this exposure has resulted in some increased funding for colon cancer research, and the future looks promising.
Melanoma, the most deadly form of skin cancer, is primarily related to excessive sun and ultraviolet light exposure. In the United States, the lifetime risk of developing melanoma has increased dramatically from 1 in 1,500 individuals in 1935 to a staggering 1 in 75 today. The statistics for Californians are even grimmer. According to the California Cancer Registry (CCR), the state’s population-based cancer surveillance system, there were 5,700 new cases of invasive melanoma in 2007 and more than 800 deaths, the highest statistics of any state in the nation. CCR reports that in California, the incidence of melanoma has increased by 15% in the last decade. The number of cases of melanoma increases dramatically with age, with half of all cases occurring in adults 50 years of age and older. With the median age of patients around 50, the years of lost productivity is greater than most cancers.
Even more disturbing is a recent University of Southern California study, which examined more than 700,000 cancer cases in Los Angeles County over a 25-year period. The study demonstrated that rates of most cancers are declining in the county, but rates for melanoma are increasing dramatically. The study revealed that melanoma case numbers have increased so quickly in the last 20 years that it is now one of the region’s five most common cancers, with similar alarmingly increasing incidences in all parts of the State.
Melanoma, when identified early, is curable by surgery alone, but once it has spread throughout the body (metastasized), the chance for survival is poor. Few patients with advanced melanoma are eligible for potentially curative surgery. Unfortunately, melanoma is also relatively resistant to chemotherapy or radiation. Biologic agents such as interferon and interleukin-2 have not significantly improved survival rates, and these agents are quite toxic.
These are the only two drugs that have been FDA-approved for the treatment of melanoma in the last 30 years, while numerous drugs have been developed both in the United States and abroad. With the incidence of melanoma increasing, and very few new drugs being approved, there is a clear need to develop further treatments.
Breast Cancer
In 2008, it is expected that 182,000 women in the United States will develop breast cancer, making it the leading cause of cancer morbidity second only to lung cancer in death rates. Similar to other solid tumors such as melanoma and GI malignancies, control of the initial disease is critical, as the presence of local or regional metastases can lead to disease progression and ultimately, patient death. While a variety of targeted therapies have been developed in recent years focused on treatment after the tumor has spread, the cure for breast cancer will come with improvements in understanding the mechanisms of disease initiation and metastases to the regional lymph nodes. Critical to working toward the cure, are improvements in early diagnosis through screening tests (imaging) and surveillance.
Although a number of methods can increase the detection of micrometastases, i.e., small metastases that are difficult to identify by standard examination, these techniques are usually too costly for routine evaluation of surgical specimens. Sentinel node biopsy (SNB), a selective surgical sampling technique to identify the first tumor-draining lymph node, has been widely accepted for its accuracy in melanoma and breast cancer. However, despite this test being incorporated into routine cancer care, the test is not always accurate, and the status of the sentinel node doesn’t always predict the outcome of the patients. New methods of evaluating the sentinel node or improved methods of analysis of the primary tumor could lead to improved methods of staging disease status and predicting patient outcome.
For all cancers, imaging is critical for diagnosis, staging and judging responses to therapy. Improvements in traditional imaging such as CT and MRI have made been made in recent years, yet the ability to accurately determine patient eligibility for surgery and/or chemotherapy remains imprecise and other methods to determine responses to therapy and comparison to the tumor biology are poor. The development of whole-body positron emission tomography (PET) imaging using radio-labeled glucose derivatives has improved imaging, but remains untested for judging tumor biology.
Stem cell research will likely provide the key to understanding the biologic evolution of malignancies, especially breast cancer. As part of this research effort, embryos in young women can be frozen prior to receiving chemotherapy and given back to these patients when treatment is completed in the event they wish to have children.
Oncoplasty describes reconstructive approaches after cancer treatment and in women after mastectomy. Understanding cellular mechanisms of wound healing and tissue regeneration is fundamental to achieve a better cosmetic result.
With a recent study demonstrating that psychological wellness reduces breast cancer recurrence by 50%, it is essential to work in a center that provides all the necessary components. These include psychological support, massage therapy, meditation, and acupuncture.
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