Killing Cancer: Will a Targeted Approach Yield Results?

Killing Cancer: Will a Targeted Approach Yield Results?

A diagnosis of cancer is one of the most shattering pronouncements an individual can hear. But institutions such as The Cancer Institute of New Jersey (CINJ), based in New Brunswick, New Jersey—the state’s only National Cancer Institute-designated Comprehensive Cancer Center—can offer a lifeline of hope.

COMMERCE spoke with Chief Medical Officer Deborah Toppmeyer, M.D., about the latest advances in improving the prevention, detection, treatment and care of patients with cancer. A resident of the Belle Mead section of Montgomery Township, New Jersey, she has been with the CINJ for 17 years and is involved with operations and strategic planning for the assessment, improvement and targeted growth of the institution’s clinical programs and service.
Dr. Toppmeyer’s many responsibilities also include promoting quality within the cancer center; overseeing clinical faculty supervision, development and performance management; and working closely with staff, department directors and physicians to ensure that the CINJ’s highest standards of quality and service are maintained.

COMMERCE: How did you get involved in the medical field and with oncology in particular?

DR. DEBORAH TOPPMEYER: As a child, I was interested in science, and I also enjoyed volunteering as a way to give back to the community. In college, those interests and desires led me to study medicine. Then I found that oncology gave me a chance to treat the “whole” patient, and the opportunity to get involved with patients’ families too, explaining the course of treatments and helping them to deal with outcomes. Oncology is an incredibly stimulating field, working with researchers, physicians and others in a rapidly advancing area of modern medicine.

Q. On a scale of 1 to 10, how would you rate the public’s awareness of cancer issues, with 1 being a lack of awareness and 10 being fully aware?
A. It’s difficult to answer that, because the challenge in America isn’t so much the level of awareness, but rather the willingness of individuals to act on recommendations.

“Cancer does not refer to a single disease, but is a spectrum of diseases,” says Dr. Toppmeyer. “The drivers, or causes, can be different across a variety of cancers, like lung or neck, or breast cancer, and can vary within each cancer.”Q. Could you please elaborate on that?
A. Thanks to the efforts of the Surgeon General, a number of cancer organizations and the media, I’d say that most people have some sort of awareness of cancer, and of the way that lifestyle activities such as exercise, diet, refraining from smoking and early detection can help to reduce the risk of cancer. Despite that, about 20 percent of Americans continue to smoke, and obesity, particularly in the young, is reaching epidemic levels. Outreach programs are in place, but it’s still a matter of raising the level of individual responsibility. Physicians and others can make recommendations, but if a patient chooses not to follow them, then we’re limited in what we can do.

Q. What are the biggest challenges to conquering cancer?
A. The first thing is to recognize that cancer does not refer to a single disease, but is a spectrum of diseases. The drivers, or causes, can be different across a variety of cancers, like lung or neck, or breast cancer, and can vary within each cancer. So when you’re searching for answers about cancer, you can’t really talk about one treatment, because each type of cancer has its own genetic signature, and what works well with one cancer may have no effect on another type of cancer.

Q. Which cancers are we best able to treat and which ones are the most deadly?
A. We have made great advances in the treatment of certain cancers such as pediatric, all breast cancer and lymphoma, for example. However, in the past, cancers such as metastatic melanoma and lung cancer have had low survival rates; but now, by identifying specific mutations within subtypes of these cancers, novel therapies have been developed that target these specific, genetic alterations. This has changed the natural history and course of these diseases for select patients.

Q. What are the most promising areas of cancer research? What will the next big breakthrough?
A. Right now, The Cancer Institute of New Jersey and other institutions are engaged in an approach known as precision/personalized medicine, where systems biologists and other specialists collaborate with scientists and clinicians to identify the molecular alterations associated with cancer, and then tailor regimens of targeted agents to those specific alterations or mutations. So instead of taking a shotgun approach to killing a cancer cell, we are using a targeted approach that is not necessarily specific to an anatomical site, but rather the specific mutation identified in the tumor. Ultimately, this knowledge may shift the paradigm of treating specific cancers of origin such as breast, lung and colon to treating unique mutations shared by many different tumor types. We’re seeing encouraging results, including the development of more effective drugs with increased efficacy and decreased toxicity, and the ability to better use existing ones, with improved delivery and fewer side effects. But there’s still much to learn and more progress needs to be made

Q. Where does The Cancer Institute of New Jersey get its funding?
A. The Cancer Institute of New Jersey is funded from state and federal grants and appropriations, philanthropic support and other sources.

Q. Have you been affected by federal and state budget cutbacks? How are you dealing with them?
A. Like all cancer centers throughout the country, reductions in cancer research funding are impacting our ability to make discoveries faster. It is important that we are able to continue making advances in treatment options and disease etiology.

“When you’re searching for answers about cancer, you can’t really talk about one treatment, because each type of cancer has its own genetic signature, and what works well with one cancer may have no effect on another type of cancer,” explains Dr. Deborah ToppmeyerQ. What are the most common or rare cancers in New Jersey?
A. There is really no spectrum of cancers that are associated specifically with New Jersey. You could perhaps say that some types of cancer, such as breast cancer—that tend to strike women who bear children when they’re older—may strike urbanized states like New Jersey where women may defer giving birth while they pursue their careers, more often than rural states. But that’s more of a demographic relationship, not a geographic one.

Q. Are enough screening and other preventative measures being taken? What can be done better?
A. As I noted earlier, there is a basic awareness of screening recommendations in the general population that is reinforced by a patient’s primary care physician. However, it is still up to the patient to follow screening guidelines. It is recommended women undergo annual mammography screenings beginning at age 40, while men and women over 50 should get a colonoscopy, for example. It’s important to establish a close relationship with your primary care physician and follow through with the recommended exams and lifestyle changes.

Q. What are some risk factors and some myths about what causes cancer?
A. Lifestyle modifications can play a role in reducing one’s risk of developing cancer. However, some people compartmentalize their health concerns, and focus on factors that may have no impact on risk while ignoring those that are clearly associated. For example, a heavy smoker may worry more about his or her nutritional/vitamin intake while ignoring the need to pursue smoking cessation. Or an individual may worry about developing cancer from deodorants or antiperspirants (a myth), but yet opt to forego sunscreen to get the perfect tan despite the proven risks of developing melanoma from excessive unprotected sun exposure. And of course, many people do not exercise on a regular basis or make the optimal food choices and there are strong data to suggest an increased risk of cancer associated with obesity. These simple lifestyle choices can have a significant impact on cancer risk.

Q. At the end of the day, how do you feel about the battle against cancer? Are we winning?
A. There is still so much that we need to continue to discover and learn, but we have made significant advances that have the potential of changing a cancer patient’s future. When you care for a patient who developed stage IV breast cancer more than a decade ago, have the opportunity to treat her with a new targeted therapy for her specific type of breast cancer and 12 years later watch her send her daughter off to college, there are no words that can describe this extraordinary journey.

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