Special Cancer Feature
Attacking cancer
Donna Van Ryn in her front yard. Photo by Bart Harris
Scorpion Venom Keeps Brain Tumor in Check A drug derived from scorpion venom appears to be helping a 49-year-old Tinley Park, Ill., woman beat the odds. Diagnosed in December 2005 with a deadly glioblastoma multiforme, Donna Van Ryn has lived almost three times the median survival of 15 months — and feels fine. She has been through two brain surgeries to remove her cancer, which oncologists suspect is the same type as the late Sen. Edward Kennedy’s. She went through aggressive radiation and chemotherapy, and two clinical trials of investigational drugs. But the treatment to which she is currently responding
involves a medication fashioned from a scorpion’s sting. Van Ryn says she now feels better than she ever has since noticing her first symptoms, and her scans show no evidence of recurrent disease. She walks three miles a day and just started a new job as a secondgrade teacher. “I’m pretty much back to my normal self,” she said. The drug, known as I131-TM601, is produced by TransMolecular, Inc., a small biotechnology company based in Cambridge, Mass., that focuses on targeted therapies for cancer. It combines radioactive iodine (I131) with a piece of a toxin (TM601) derived
from the venom of the Israeli desert scorpion, ominously referred to as “deathstalker.” The toxin fragment recognizes and binds to receptors found on the surface of glioma cells while bypassing normal, healthy cells. It is given intravenously, enabling it to travel throughout the body and target tumor cells. Within the brain, it “shockingly homes right in on glioma cells,” said trial director Steven Chmura, MD, PhD, radiation oncologist at the Medical Center. “We often talk about targeted therapy, but this is far more targeted than most of what we see.”
Team Pairs Cardiac and Vascular Specialists For decades, physicians at the University of Chicago Medical Center have provided patients with state-of-theart diagnostic and treatment services for all types of aortic diseases. The University of Chicago Aortic Specialty Team (UCAST), formed in 2009, ensures that patients who require elective or emergent intervention for complex aortic conditions benefit from expedient and coordinated care from a multidisciplinary team of cardiac and vascular specialists. UCAST provides patients the most advanced care with both straightforward and complex aortic disease using minimally invasive approaches whenever possible. 1
The team recently cared for a 68-yearold man who came to the Medical Center with a large dumbbell-shaped aortic aneurysm involving the blood supply to the gut and kidneys (Figure 1), a dangerous bulge in the life-supporting blood vessel that can lead to fatal rupture. Using minimally invasive endovascular techniques best performed by highly skilled surgeons at an academic medical center, the team repaired the aneurysm in two stages. During the first stage, blood supply was redirected to the gut and kidneys utilizing a multibranched bypass around the diseased portion of the aorta, allowing continued blood flow and greatly 2
thoracoabdominal stent graft
T debranching graft
reducing the risk for liver, intestinal and kidney damage during the rest of the procedure. In the second stage, the surgeons deployed a specialized covered stent from the distal thoracic aorta to the iliac arteries. By diverting blood flow through the covered stent, the blood pressure and tension on the aneurismal aortic wall was virtually eliminated (Figure 2). The patient had an uncomplicated recovery and quickly returned to his usual daily activities. “This case epitomizes the strategy of the University of Chicago Medical Center,” said Jai Raman, MD, PhD, codirector of UCAST, “which is to develop and deliver techniques that treat high-risk patients with lower mortality, less trauma and shorter recovery time.” Hisham Bassiouny, MD, co-director of UCAST and chief of the Section of Vascular Surgery and Endovascular Therapy at the Medical Center, agreed: “Without access to the highest level of care provided by highly skilled specialists, this patient may have experienced significant organ damage, or, in the worst case scenario, death. We are pleased to be able to bring life-saving techniques to patients like him who require a collaborative approach to care.”
from every angle
By Rob Mitchum With contributions from Don Reneau and Susan Chandler Cancer has been a deadly riddle without a solution for centuries. The desperation to find a cure led to unusual theories from visionary scientists, such as Leon Jacobson, MD, at the University of Chicago in 1943. Observing that soldiers exposed to the chemical weapon mustard gas exhibited low white blood cell counts, Jacobson proposed that the toxin could be used to treat leukemias — cancers that produce an excess of those very cells. The experiments worked, and what we now know as chemotherapy was born. Many patients showed remission of their cancer when exposed to nitrogen mustard, the active ingredient of mustard gas, but at a price — the side effects were severe and unpleasant. A tool for treating cancer had been found, but it took the coarse strategy of using poison to cure. In today’s cancer treatment, the strategy is the same, but the tools are far more advanced. A cancer patient lies immobilized on a platform in a dark room of the Duchossois Center for Advanced Medicine. Silently, a meshwork of lasers crisscrosses his body, almost completely covered by a protective lead gown. Above his head, a mechanical arm glides in a semicircle, imaging the patient’s tumor immediately before firing beams of radiation from multiple finely calibrated angles calculated by a powerful computer. The procedure, Image-Guided Radiation Therapy, or IGRT, shares a purpose with the chemotherapy of nearly 70 years prior: to kill cancer cells with a destructive force. But rather than applying radiation broadly and damaging healthy cells along with cancerous ones, IGRT uses the latest technology to focus radiation directly at the tumor, minimizing collateral damage and side effects. The University of Chicago Medical Center and Joseph Salama, MD, assistant professor of radiation and cellular oncology, were the first to bring IGRT to patients in the Chicago area. But IGRT is only one of a multitude of breakthrough cancer treatments currently applied, researched, or developed at the Medical Center,
where more than 200 physicians and scientists constantly seek new ways to outsmart this deadly disease. “It’s not hopeless, and we are making progress,” said Ralph Weichselbaum, MD, co-director of the Ludwig Center for Metastasis Research at the Medical Center and chairman of the Department of Radiation and Cellular Oncology. Like the machinery behind IGRT, the Medical Center is attacking cancer from all angles, using every possible tool: radiation, genetics, drugs, surgery and medical engineering. With each new innovation, more cancers become treatable, side effects become less severe and optimism is restored for those stricken with the disease. “The University of Chicago Comprehensive Cancer Center really takes a multi-faceted approach that involves hundreds of individuals,” said Michelle Le Beau, PhD, professor of medicine and director of the Comprehensive Cancer Center. “One of the things that makes us so unique is that we have expertise in the whole scheme, from cancer detection to diagnosis to treatment.” The ultimate answer to the riddle of cancer has yet to be discovered. But the momentum is shifting — cancer death rates in the United States have fallen 1.6 percent each year since 2001, and 5-year survival rates for cancer patients have increased from 10 percent to more than 65 percent in the last 30 years. With recent genetic and technological discoveries bringing even more promise to the fight against cancer, researchers are optimistic that great strides will continue to be made. “These technologies simply were not available 15 years ago,” said Blase Polite, MD, assistant professor of medicine and an expert in gastrointestinal cancers. “Add to that the recent mapping of the human genome, one of the greatest scientific feats of the millennium, and we now can explore the very heart of the cancer machine and find ways to turn it off.”
Figure 1: A large dumbbell-shaped aortic aneurysm Figure 2: Blood supply is redirected by using a debranching graft.
6 University of Chicago Medicine on the Midway
Spring/Summer 2010 7