Dr. Charles Kunos
Summa Health System
Dr. Charles Kunos first discovered he had a knack for anatomy during a seventh-grade science contest, but he never knew he'd one day be using that talent to target individual cancer cells hidden deep inside people's bodies. As the new medical director of radiation oncology at Summa Akron City Hospital, he's one of the only people in the world using a Novalis machine to treat gynecological cancers in a procedure called stereotactic radiosurgery. The innovative machine helps destroy cancer cells, but it's still up to Kunos to find them. // Amber Matheson
Q. How do you find the group of cells you're targeting?
A. Most often, we get a PET scan. That gives us information about the metabolism of the tumor. The PET scan can reflect overactivity in the cancer cells so that we have both anatomical information as well as biologic information. We then, as physicians, are charged with contouring out where we think the cancer cells are residing, and we use sophisticated computer programs to come up with radiation treatment angles and beam strengths to target the cancer cells.
Q. How accurate is the machine?
A. The patients don't wear lead aprons. We're trying to use the radiation to actually kill the cells. The Novalis machine is capable of stereotactic radiosurgery, in which we use pinpoint radiation targeting and localization, [which] allows us to precisely treat cancer cells and spare normal cells from injury. In the machine, there are what we call collimators that shape the beam so that it literally just treats the cancer cells and not anything else. It does go through the skin and organs to target the cancer, [but] the normal cells will see only a fraction of the high-intensity radiation doses; but you can imagine where all the beams are crossing, there's a build up of the radiation dose.
Q. How is this treatment different from the typical course of action?
A. Typically, radiation therapy for women with gynecological cancers that have spread other places in the abdomen or chest is three-, four-, or five-week courses of care. This platform allows the treatment to be done in three days.
Dr. Stanton Gerson
University Hospitals Seidman Cancer Center
Most doctors juggle more than medical charts. Just ask Dr. Stanton Gerson, the director of the University Hospitals Seidman Cancer Center. He works with researchers, patient caregivers and administrative workers, while still making patient rounds twice a week. He even found the time to lead a research team, which created two new cancer therapies already showing signs of success, including TRC102, a compound that helps prevent tumor regrowth. And on top of that, he oversees the Case Comprehensive Cancer Center, a National Cancer Institute-designated collaboration among Case Western Reserve University, the Cleveland Clinic and University Hospitals. // Amber Matheson
Q. Why is the Comprehensive Cancer Center so important?
A. It coordinates the cancer research and delivery of new therapies, especially using clinical trials, throughout the region. We see more than 15,000 patients a year under the auspices of the National Cancer Institute. You wouldn't want the institutions to do [the research] three times. It is incredibly exciting because of the diversity of efforts we have and the accomplishments we're making: imaging sciences, new drugs, seeing the teams working together across the institutions.
Q. What is TRC102?
A. It's a compound that makes cancer chemotherapy work better. If we give TRC102 with chemotherapy, the tumor can't repair the damage [caused by chemo], and the tumor cell dies. We made the initial discovery of a pathway [created by the tumor itself]; that tumor-repair pathway reduces the effect of a whole variety of drugs. [TRC102] blocks the tumor-repair pathway. The drug itself isn't very effective unless it's given with chemotherapy.
Q. What are some of the biggest misconceptions in your line of work?
A. There's a reticence the public has of participating in a clinical trial, and most often, a clinical trial is the best treatment we can possibly offer our patients. The second general misconception is that patients need a second opinion, when what they really need is a group consensus. We use a team of experts. The total number involved for each cancer area may be 15 to 35 experts. They use publications, national standards and recent research to inform [their] decision. Once there is a consensus by the experts, the final treatment decision is discussed with the [patient's] primary care physician.
Dr. Lyndsay Harris
University Hospitals Seidman Cancer Center
Breast cancer is the second most common cancer among women in the U.S. Though the individual genetic makeup of cancer is different for everyone, breast cancer patients have been given the same treatments. Dr. Lyndsay Harris, director of breast cancer research at University Hospitals Seidman Center, says studying the genetic sequencing of a person's tumor can result in more effective, personalized treatment plans. This spring, she will begin a clinical trial of 168 women with early-stage breast cancer to help catalogue the best treatment options for breast cancer's various genetic mutations. // Rebecca Meiser
Q. What will this study accomplish?
A. We hope to know from within 10 days to two weeks of starting treatment whether a woman needs to stay on the therapy she's on or switch to something better.
Q. What does this mean for treatment?
A. We're in the middle of a genomic tsunami. We're dealing with an absolute revolution in understanding disease and being able to implement treatment. Knowing the disease you have and treating it correctly will improve the length and quality of a patient's life.
Q. Can it also be used for other cancers?
A. The short answer is yes. [Genome testing] is an area of great interest for all cancer research: colon and lung cancer. Because each cancer has its own type of mutation, all these studies are important to do. But genome research is a little easier to do with breast cancer than say, lung cancer. That's because with lung cancer, it's hard to get access to the tumor.
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