Vaccine may shift odds against deadly brain cancer

Vaccine may shift odds against deadly brain cancer

By Caleb Hellerman, CNN
March 4, 2010 10:31 a.m. EST
Vaccine attacks brain tumors

STORY HIGHLIGHTS
Vaccine called CDX-110 triggers immune system to attack cancerous brain cells

T-cells, antibodies attack the tumor cells

One patient has survived six years in the vaccine trial

RELATED TOPICS
Brain Cancer
Duke University
Johns Hopkins Medicine

Durham, North Carolina (CNN) -- The first week of each month, Karen and Jerry Vaneman pack their car for a four-hour drive from Asheville, North Carolina, to the medical complex at Duke University. Inside the Preston Robert Tisch Brain Tumor Center, Karen waits patiently as a parade of doctors and technicians pokes and prods, taking samples of all kinds. On this day alone, she gives 21 vials of blood.

In March 2008, Karen was working out in the gym at UNC-Asheville when her left arm went limp. She felt so faint and dizzy that she had to sit. When the Vanemans first got to the emergency room, the doctors were afraid that Karen was suffering a stroke or heart attack.

In fact, Vaneman, a retired professor of Shakespeare and medieval literature, had brain cancer: a glioblastoma or GBM, the most common type of brain tumor. Many doctors consider it a death sentence, but not the team at the Preston Robert Tisch center, where Vaneman was directed for surgery and post-operative care.

"Other doctors will tell you you've got six to nine months, maybe a year to live," says Dr. Henry Friedman, the center's director. "'You're incurable; move on with your life the best you can.' But it's a self-fulfilling prophecy."

At Duke, aggressive treatment is the rule. Almost every patient is enrolled in a clinical trial. For Vaneman, that meant a novel vaccine.

The vaccine, based on research done at Duke and Johns Hopkins, and produced by Pfizer, is called CDX-110. It's not a vaccine in the traditional sense: It doesn't prevent disease. But like any vaccine, it triggers the immune system to attack an intruder, in this case, the cancerous cells.

"All the cells in our body have a [genetic] fingerprint," said Dr. John Sampson, a surgeon and researcher who helped develop the vaccine. "The immune system can recognize differences in those fingerprints."

CDX-110 targets a particular protein -- one with the unwieldy name of EGFRviii, or "EGFR factor three." There is a huge amount of genetic variation within even one patient's tumor, which is one reason the disease is so hard to treat. But according to Sampson, about 40 percent of tumor cells produce EGFRviii. It acts like a homing beacon for the disease-fighting immune cells that are stirred up by the vaccine.

"We're using white blood cells called T-cells, antibodies, to attack the tumor cells because [the tumor cells] have a different fingerprint from the normal cells in the body," Sampson says.

"Unlike chemotherapy, which really hurts all dividing cells in the body, or radiation... the immune system can be absolutely precise. And so we get a very tumor-specific attack with very low toxicity," he says. That means patients suffer fewer side effects.

A vaccine approach is not unique to brain cancer; several are under investigation. Last summer, researchers presented data showing that another vaccine could extend survival for prostate cancer patients.

CDX-110 is not the only candidate for a brain cancer vaccine, either. A project at the University of California, San Francisco, takes a more radically personalized approach. The vaccine for each GBM patient is custom-made from that patient's own tumor cells. Each drug is one-of-a-kind.

"This is the ultimate personalized medicine," says Dr. Andrew Parsa, the neurosurgeon who is running the trial. "It's like having a lot of little medicines instead of one big blockbuster."

The vaccine works -- he hopes -- by targeting something called a heat-shock protein, which is produced in high quantity by tumor cells.

Another novel aspect of the UCSF research is that it doesn't involve a pharmaceutical company as a backer. Instead, it's funded completely by the National Cancer Institute and a handful of cancer nonprofits.

One of the funders, Deneen Hesser, research director of the American Brain Tumor Association, says the research on vaccines is exciting and about expanding the realm of possibility.

"Vaccines represent treatment options," Hesser says. "For patients to be able to have choices, choices in how to approach a treatment plan, is really much different from historical approaches to treating brain tumors."

The UCSF trial is still in its early stages. The current Phase 2 trials -- testing whether the vaccine is effective -- have been enrolling patients only since last summer. The research with CDX-110 is further along, but results from the first multicenter trial will not be made public until later this spring. Forty-four hospitals and medical centers are participating.

At least one of Sampson's patients has made it six years without his tumor coming back. Still unclear is just how many other patients can benefit. Parsa, at UCSF, says his hospital tested 14 patients for the multicenter study. Only one had a tumor that was vulnerable to the vaccine.

In Asheville, Karen Vaneman calls herself lucky.

"In the last year, I've been more mindful of my priorities," Vaneman says. "My family, and the granddaughter, and my husband who has been like a rock through the whole thing. And beyond that, trying to keep a connection with the rest of life, too -- the birds, the bees, the rocks, things like that."

She's hiking again through the hills around Asheville, although she limits the walks to about 2 miles these days. She feels good. And she's happy, more than happy, to put up with the monthly trips to Durham.

"As long as the vaccine works, I'll be getting the monthly shots. And when it doesn't work [any more], then I'm in trouble."

Comment

Those who frequent this blog probably know that my Mom died of lung cancer. She went thru 4 course of chemo and radiation, and succumbed after 18 months. It was not a pretty way to go.

Microsoft software to let patients see medical records

March 1, 2010 7:02 AM PST
Microsoft software to let patients see medical records
by Lance Whitney

Microsoft is unveiling new health care software that will give you a glimpse of your own medical records online.

The company on Monday announced its new HealthVault Community Connect software, which is geared toward hospitals interested in helping patients access their own health care history.

Following a hospital stay, you and your personal doctors can view electronic copies of your hospital records online. Using the software, you can also preregister for future hospital appointments using your existing medical information.

You log onto the hospital's patient Web site, said Microsoft, where you can call up physican notes, discharge instructions, prescriptions, and lab and radiology results. You can send copies of your hospital records to your personal HealthVault account, if you have one. HealthVault is a free service from Microsoft that lets you store and organize all your health care records online.

Your personal doctor or referring specialist can also request access to the system to keep on top of your hospital care and ongoing treatment. Microsoft said that the hospital will control the list of outside physicians who are able to tap into your records.

"With HealthVault Community Connect, we are targeting one of the fundamental gaps in the care process -- the lack of electronic information flow between the hospital, the patient and the patient's care team outside the hospital," said David Cerino, general manager of Microsoft Health Solutions Group, in a statement. "By allowing patients and their personal physicians to access electronic copies of their discharge instructions, for example, hospitals can facilitate better health outcomes by getting the relevant information into the hands of the people who need it most."

HealthVault Community Connect was announced at 2010 Annual Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition, a health care trade show taking place in Atlanta this week.

The software is designed for any size hospital, said Microsoft. It can also integrate with a hospital's existing network enviroment and run on Microsoft's SharePoint Server. HealthVault Community Connect is slated to debut in the third quarter of this year.

With the push toward lowering medical costs by modernizing the system, Microsoft has been one of several tech companies introducing new health care products. Last year, the company formed a venture with CVS to let people download their prescription information to their HealthVault accounts. It also has been buying companies to enhance its medical portfolio, most recently picking up health care sofware maker Sentillion in December.

Microsoft's Amalga product line is designed to help doctors and patients more easily access and organize medical records and is currently being used in large hospitals such as New York-Presbyterian.
Lance Whitney wears a few different technology hats--journalist, Web developer, and software trainer. He's a contributing editor for Microsoft TechNet Magazine and writes for other computer publications and Web sites. You can follow Lance on Twitter at @lancewhit. Lance is a member of the CNET Blog Network, and he is not an employee of CNET.
Topics: Hospitals, Health recordsTags: Microsoft,HealthVault,health care,e-healthShare: Digg Del.icio.us Reddit Yahoo! BuzzFacebook Twitter

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HealthLinx identifies novel ovarian cancer biomarker Add a Comment (Log in or register) (8 Comments) prev next by dt1991 March 1, 2010 7:28 AM PST
sounds like a good program
Like this Reply to this comment by solitare_pax March 1, 2010 8:00 AM PST
True - but how secure is it?

And how is the data presented?

Once people start seeing $20 words for their issues, they'll start hunting the web for drugs or cures to offset their ailments without consulting the doctor.

And how long before free becomes 'sponsored by the "makers of the plaid pill"? or whatever?
Like this by mudphud March 1, 2010 9:04 AM PST

Hard to say. I'd have to see it in action. There are multiple hospital medical record and scheduling systems, I doubt this system will work with them very easily. It will probably require a lot of customization. It would be better to establish a single common medical record format. Unfortunately, the medical software companies prefer to lock hospitals in with custom databases.
Like this by fudbuster77 March 1, 2010 9:25 AM PST

I don't like Microsoft OR Google having my health records in their control- Heck, I don't even like the idea of my own Chosen Company of Great and Glorious Apple to have that sort of information. I just don't trust it-

HOWEVER

I have also had experience and exposure to how poorly the health care industry actually secures data and patient records. In this regard, I would rather trust Microsoft/Google than our own health care companies as they have demonstrated they have zero clue when it comes to IT Security.
Like this Reply to this comment by Mr. Dee March 1, 2010 12:30 PM PST

Sooner or later this is what you will have to do because its way more efficient.
Like this by ehfla March 1, 2010 1:32 PM PST

Long live paper records! Yeah fudbuster....let's keep the current system where doctors have to wait hours or days to view x-rays, or days or weeks to get lab results. Better yet....how about the stone tablet?
Like this by globalist_agenda March 1, 2010 10:21 AM PST

Why aren't hospital prices posted? Don't you think that when consumers spend 1/6 of the GDP on healthcare that they should be able to see medical prices for fees and services BEFORE they make a purchase? If McDonald's didn't tell you in advance how much that $1 chicken sandwhich costs the state and Fed bureacrats would shut them down in 30 minutes.

Face it Demo-Pubs, there is virtually no transparancy in the healthcare system because you get a large chunk of your campaign funding from Big Pharma and Big Medicine and the last thing they want is an informed consumer.
Like this Reply to this comment 1 person likes this comment
by mental_floss March 1, 2010 1:40 PM PST

Given Microsoft's track record on privacy and security issues you might as well post your health records on a public blog. My hopes are they fail, as they have so often lately (Zune, Bing, phone OS) and let companies with at least a shred of moral backbone provide health care record services.

Comment

The VA has had computerized medical records for over ten years now. Any doctor with the proper permission can access the records of any patient anytime, anywhere.

Detecting cancer through laser-induced ultrasound - CNET

February 24, 2010 1:36 PM PST

by Elizabeth Armstrong Moore

(Credit: Pinar Istek)
To determine if there is cancer in one's lymph nodes, a typically advanced stage requiring more aggressive treatment, pathologists are stuck performing several specific, detailed tests that may or may not target the cancerous cells. Using the needle-in-a-haystack analogy would be apt.

But thanks to the work of researchers at the University of Missouri in Columbia, a technique using photoacoustics could scan a lymph node biopsy with laser pulses, whereby the pigment of melanin reacts to the laser's beam, absorbing the light, and heating and cooling (read: expanding and contracting) rapidly. This produces a popping sound that's detectable by special sensors.

Using this new method, pathologists could soon be able to examine an entire biopsy and identify the general area of the node that has cancer, giving pathologists a better (and faster) idea of where to look for the cancer.

"It's very similar to identifying a prize inside a cake," says John Viator, assistant professor in the departments of biological engineering and dermatology, in a news report this week:

"Instead of looking through the entire cake, we can use our ultrasound to pinpoint a slice or two that might contain the 'prize,' he said. "In the case of the lymph nodes, when you get a signal, this alerts the pathologist that this is an area of the node that might contain cancer cells. At that point, a pathologist would be able to narrow down the search, saving time and money."

Since a paper outlining Viator's research, titled "Photoacoustic Detection of Melanoma Micrometastatis in Sentinel Lymph Nodes," was published in the Journal of Biomedical Engineering in July 2009, he has partnered up with University of Missouri Professor Jae Kwon, whose home cancer detection kits we covered last week. The team is investigating how gold nanoparticles might be able to "tag" non-melanoma particles to extend this work to other types of cancer, such as breast cancer.

"Melanoma has its own native pigment, melanin, but the breast cancer cell, say, doesn't have its own color, so is invisible to laser light," Viator said. "But we're working with a group on campus that is functionalizing nanoparticles, basically painting these cells with color so we can do this same type of photoacoustic identification in other cancers."

Viator says he hopes to commercialize this new technology, which he calls "an important tool in our fight against cancer," in the near future. His most recent work on photoacoustics is due to appear in the Journal of Biomedical Engineering in the coming months.

E-prescriptions more reliable than handwritten ones - CNET

February 26, 2010 1:09 PM PST
E-prescriptions more reliable than handwritten ones
by Elizabeth Armstrong Moore

Chicken scratch is one reason handwritten prescriptions contain more errors than e-prescriptions.

(Credit: mandiberg/Flickr)
Here's one for the important-but-obvious files.

New research at Weill Cornell Medical College in New York finds that medical professionals writing prescriptions by hand are seven times more likely to make errors than those using electronic systems.

Researchers looked at prescriptions written by health care providers at 12 community practices in the Hudson Valley region of New York. They compared the number and severity of the found errors between 15 providers who wrote prescriptions by hand and 15 who used a commercial system that provides dosing recommendations and checks for drug allergies, duplicates, and combination effects.

The researchers inspected 3,684 paper-based prescriptions at the start of the study and 3,848 paper-based and electronic prescriptions written one year later. After one year, the percentage of errors for providers using the electronic system dropped from 42.5 to 6.6. For those writing prescriptions by hand, the percentage of errors held almost steady, increasing slightly from 37.3 percent to 38.4 percent.

Errors in both types of prescribing included incomplete directions; omission of quantity; and even the more egregious error of incorrect dosages. Illegibility, which led to errors in handwritten prescriptions, likely accounts to some degree for the fewer errors in e-prescribing.

"Although most of the errors we found would not cause serious harm to patients, they could result in callbacks from pharmacies and loss of time for doctors, patients, and pharmacists," says senior author Erika Abramson, assistant professor of pediatrics at Weill Cornell Medical College. "On the plus side, we found that by writing prescriptions electronically, doctors can dramatically reduce these errors and therefore these inefficiencies."

The study received funding from the Agency for Healthcare Research and Quality.

New surgical bone screw biodegrades in two years

March 1, 2010 11:54 AM PST
by Elizabeth Armstrong Moore

For years, people with broken bones have had to suffer through not only the pain of the break, but also the long process of healing, often with the help of titanium screws. Typically, patients must then undergo more surgery to remove the titanium.

When my mom broke her knee in the '90s, they rigged her with so many screws and bars that her X-rays looked more robot than human. She predicted rain with eerie accuracy.

(Credit: Fraunhofer IFAM) This month, researchers at the Fraunhofer Institute for Manufacturing Engineering and Applied Materials Research (IFAM) in Bremen, Germany, are unveiling a new type of screw that not only biodegrades within two years but actually encourages bone growth into the implant itself so as not to leave gaping holes where the screws used to be. (This has been one goal of fracture putty as well.)

Current biodegradable screws are made of polylactic acid, but those leave holes once they degrade. IFAM researchers developed a moldable composite made of polylactic acid and hydroxylapatite, a ceramic that Philipp Imgrund of IFAM's biomaterial technology department says is the main constituent of bone material.

"We have modified biomaterials in such a way that they can be formed into robust bioactive and resorbable screws by means of a special injection-molding process," Imgrund said. "This composite possesses a higher proportion of hydroxylapatite and promotes the growth of bone into the implant."

IFAM engineers rely on conventional injection-molding methods, but they developed a granulate from the biomaterials with a net shape that results in a robust screw. The prototype's properties are very similar to a real bone's, with compressive strength of more than 130 newtons per square millimeter (a real bone withstands 130 to 180).

Moreover, the temperature required for compression is about 280 degrees Fahrenheit, much less than the 2,500-degree temperatures required in typical powder injection molds. So there are energy savings to celebrate as well.

Google Health gains partners

March 3, 2010 7:14 AM PST

by Lance Whitney

Google is moving forward in the booming health care technology market.

The search giant this week announced several new partnerships designed to expand its free Google Health service.

Google Health is the company's attempt to offer an online medical portal where you can research medical conditions and issues, find doctors and health care professionals, and track down other health-related Web sites. You can also compile and store a health profile by adding test results, names of medications, insurance information, and electronic medical records from your computer or from third-party partners.

One of Google's new partners is Surescripts, a company that lets its subscribers access prescription information through the Web. The new partnership will allow Surescripts members to store and track their prescription history via Google Health, said Google. Surescripts joins other Google Health pharmaceutical partners, such as CVS, Kmart Pharmacy, and Walgreens Pharmacy.

Additionally, Google is teaming up with the University of Pittsburgh Medical Center (UPMC), Citizen Memorial Healthcare (CMH), and Iatric Systems. Patients who use these providers will now be able to link their Google Health accounts to retrieve and organize their medical records.

The final Google Health partnership announced this week is with the Withings WiFi Body Scale, a product that records your weight, mass, and BMI (body mass index) and then wirelessly sends that information to a connected device such as a computer or smartphone. People who use the scale will be able to synchronize this information into their Google Health account to keep track of their progress.

Since the launch of Google Health in 2008, the company has been touting the service as a benefit to consumers eager to find medical information and keep tabs on their own health care history. Google has made an effort to partner with an array of providers, including hospitals, pharmacies, and insurance companies, all of which sync with Google Health to offer you one site where you can view your medical information. You can also share your Google Health account with family members and doctors.

But like most services in the cloud, Google Health does raise concerns of security. Though the backend information is secured by Google, data breaches do occur even with the strongest safeguards in place. Access to your account is also retrieved through a simple Gmail password, so your medical information is only as safe as your account password.