Future of Cancer Care by Mediaplanet_USA

SEPTEMBER 2019 | FUTUREOFPERSONALHEALTH.COM

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FUTURE OF CANCER CARE

Olivia NewtonJohn

The legendary singer and actress talks about her experience battling cancer

Why collaboration could be the key to delivering the best cancer treatments The checklist that can put your mind at ease after a pancreatic cancer diagnosis

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Kayleigh 9 YEARS OLD

Acute Lymphoblastic Leukemia

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How We Can Unite and Conquer Cancer for Our Future Howard A. “Skip” Burris III, M.D., FACP, FASCO, President, American Society of Clinical Oncology

There are plenty of challenges to be faced as we look to advance our methods for treating and preventing cancer, but there are also plenty of reasons to be hopeful. In America alone, there are more than 15 million people living with a history of cancer, and this number is projected to grow to nearly 22 million within the next 10 years.

The lynchpin of this progress has always been, and continues to be, clinical research — a process through which we learn from and build on the efforts of untold numbers of researchers, clinicians, and patients. Recent advances in cancer care highlighted at the American Society of Clinical Oncology Annual Meeting indicate continued momentum for progress against cancer — more patients than ever before are benefitting from precision medicine. We are taking better aim at the unique drivers of each cancer and giving new treatment options to patients with pancreatic cancer, children with certain brain tumors, and younger women with breast cancer. We are finding new ways to use less chemotherapy without compromising outcomes, while also decreasing harsh side effects.

Let us fınd ways to lower costs, develop innovative partnerships, and cultivate a new generation of cancer doctors so people diagnosed with cancer can live longer, better lives. The road ahead A continued path of progress will not be easy and myriad challenges lie ahead; cancer is not just one simple disease. There are more than 200 types of it, which makes finding cures and treatments more difficult. In addition, too few patients enroll in clinical tri-

als, and complex factors, such as insurance status, geographic location, and rising costs, contribute to inequities in cancer care. I am optimistic, however, that we will rise to meet this challenge. The cancer community is already tackling these issues and by working together for our future, we will continue to build on the momentum and progress achieved over the last decades. In the next 10 years, let us unearth new scientific discoveries through increased clinical trial enrollment. Let us level the playing field through policy changes that ensure every person has access to high-quality cancer care. Let us find ways to lower costs, develop innovative partnerships, and cultivate a new generation of cancer doctors so people diagnosed with cancer can live longer, better lives. Let us unite to conquer cancer. n

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PLEASE RECYCLE

Rosemary’s battle:

Feeling like herself for date night.

Battle beautifully™ Walgreens has partnered with the Cancer Support Community® and Look Good Feel Better ® to provide extra training on cancer treatment side effects to our pharmacists and beauty consultants, so people living with cancer can feel more like themselves. To learn more, visit Walgreens.com/FeelMoreLikeYou

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ment. The NPCF created “Brewing Funds the Cure” with participating breweries nationwide. We’ve also partnered with Lokai Bracelets and Metro Diner to encourage donations, and tapped ABC Wine & Spirits, Russell Western Wear, Sebastian Strong, and foundational support from the Tyler Robinson Foundation. We must partner as a team to help save kids’ lives.

How a Collaborative Business Model Is Transforming Pediatric Cancer Research Each day, 43 children and families in the United States face the harsh reality of a cancer diagnosis, yet only 4 percent of the billions of dollars allocated by the federal government to cancer research funding goes toward pediatric cancer. o how do we solve such an urgent problem that affects our children’s future so deeply? To start, we must break down walls. Traditionally, cancer research is conducted within a single institution. Each has its own funding and unique set of rules, guidelines, and deadlines that can (unintentionally) silo important research. That’s where a collaborative business model can make things better. This popular business practice focuses on combining services 4 • FUTUREOFPERSONALHEALTH.COM

to help achieve a shared goal. For pediatric cancer research specifically, this means bringing together researchers from all over the country to make kids a priority and focus on solving every issue they face. At the National Pediatric Cancer Foundation (NPCF), we have developed a collaborative business model to work toward a faster cure for pediatric cancer, called “The Sunshine Project.” Thanks to this model, since 2005, the NPCF has funded four Phase 1 Clinical Trials by

keeping a network of 24 leading hospitals and spanning knowledge from top researchers across the nation. It typically takes 10 to 15 years to complete all three phases of a clinical trial. Here are some methods you can adopt to instill the power of collaboration into your organization: Partner with local businesses Channeling your business’ roots builds strong relationships with your local community and can grow it into a national move-

Open up your network Traditionally, cancer research is done within the walls of a single institution. However, the NPCF feels that connecting with industry professionals and researchers nationwide leads to groundbreaking discoveries. Host professional summits Providing a space for industry professionals to meet and discuss relevant topics can lead to the growth of your business and puts your cause at the forefront. Here, you’ll discover new methods and new minds to join your journey. Involving yourself in established summits is worth the vetting process. Just this year, the NPCF announced its effort to address improvements for our “relapsed” patients, and ensure the best diagnostic and therapeutic services. Eliminating childhood cancer is no easy task, however, the NPCF is taking steps toward that reality thanks to a more collaborative process. As we see progress made every day, other businesses nationwide should embrace this model for the best possible results that can make the greatest impact. If you’re interested in learning more about NPCF or how your business can get involved in our collaborations, please visit www. nationalpcf.org. n David Frazer, CEO, National Pediatric Cancer Foundation MEDIAPLANET

6 Things to Know About a Pancreatic Cancer Diagnosis A pancreatic cancer diagnosis can be overwhelming but there’s no time to waste in putting together a treatment plan. This checklist can help acquaint you with the resources at your disposal and put you on a path toward recovery.

Kerri Kaplan, President and CEO, The Lustgarten Foundation ave you or has a loved one been diagnosed with pancreatic cancer? It’s estimated that more than 56,000 Americans will be diagnosed this year alone, and the five-year survival rate remains in the single digits. The Lustgarten Foundation is the world’s largest private funder of pancreatic cancer research and is at the forefront of the most promising breakthroughs. The foundation is committed to helping you navigate this disease and has developed a checklist that highlights immediate steps you should take after receiving a diagnosis. Understand your disease Thoroughly understand what stage of pancreatic cancer you have. Staging cancer is a standardized way to classify a tumor based on its size, and to determine whether it has spread and to where it has spread. Staging measures the extent of the disease and will impact treatment. 6 • FUTUREOFPERSONALHEALTH.COM

Get genetic testing Inquire about having your blood or saliva tested to identify possible genetic predispositions to cancer. This testing can have implications for family members and can guide your treatment program. According to the National Comprehensive Cancer Network’s guidelines, all pancreatic cancer patients should undergo genetic testing for inherited genetic mutations, regardless of family history. Get tumor testing Tumor testing is still in the early stages of development, but if you are being treated at a major cancer center, you may want to ask about having your tumor tested for genetic mutations. In some instances, this can help identify additional therapy programs. Seek opinions from experts Get two opinions and make sure one is from a large academic institution that specializes in treating pancreatic cancer. Know your healthcare team Treating pancreatic cancer requires an interdisciplinary approach that includes your oncologist and other specialists who must be involved in your care. Continue to see other doctors who are involved in your overall care, such as your internist.

Contact your insurance company Thoroughly understand your health insurance policy. Know what services are covered and what your out-of-pocket obligation will be per calendar year. Request a case manager to help you optimize your benefits and navigate the intricacies of your policy. As overwhelming as a pancre-

atic cancer diagnosis can be, it is important to act quickly and put a treatment plan into place, as there are therapies available from which you can benefit. To learn more about the research and patient resources at The Lustgarten Foundation, as well as treatment options, visit lustgarten.org or call (866) 789-1000. n

The New Oral Therapy That Attacks Cancer’s Unique Metabolism From the Inside, Out SPONSORED

Biotechnology company Tyme Technologies, Inc. is studying di�ferent therapeutic approaches to target cancer’s unique metabolism. By advancing investigational proprietary cancer metabolism-based therapies (CMBTs™) for difficult-to-treat metastatic cancers, they’re looking to do something different from traditional cancer care. “This is a next generation approach that is designed to both control cancer and allow patients to have a more normal quality of life,” says Ben Taylor, president and chief financial officer of Tyme Technologies, Inc.

Attacking the cancer externally has been the approach in recent years, but that’s changing. New approach “This approach is the opposite of chemotherapy,” says Taylor. “Rather than try to destroy cancer from the outside, it inserts a Trojan horse into the cancer. You’re killing the cancer cell from the inside.” Here’s how it works: cancer cells need special amino acids to thrive and this new metabolic approach makes one of those amino acids dysfunctional. The cancer cells don’t recognize the metabolic treatment as being anything foreign so they don’t try to fight it. So far, it seems to be having a significant impact. Take pancreatic cancer patients for example. Every year, 50,000 Americans are diagnosed with the deadly disease

that happens when pancreatic cells grow out of control to form a tumor. The outlook is grim — 93 percent of patients do not survive five years after diagnosis. “Most treatments for pancreatic cancer kill the healthy cells, in addition to the cancer cells,” says Michele Korfin, Tyme’s chief operating officer. “This treatment was developed to target just the cancer cells.” The biotech company TYME developed and is studying an investigational oral cancer metabolism-based therapy, SM-88, for patients with metastatic pancreatic cancer. So far, the drug has had “encouraging tumor responses” across 15 cancers with minimal serious adverse events. Korfin says data was recently presented showing patients with thirdline pancreatic cancer

have a prognosis of living two to two-and-a-half months. But with this new metabolic treatment in development, many of these same pancreatic cancer patients had a life expectancy of almost sixand-a-half months. The same drug is also being studied in patients with prostate and sarcoma cancers. TYME will be looking into starting trials for other cancers in the near future. Right now, there’s an urgent need for cancer therapies since the United States has an increased prevalence of late-stage cancer patients. Improved outcomes TYME wants to help cancer patients have more options to improve and extend their quality of life. They welcome a broad range of patients to their trials, including recruiting patients who are very sick. Patients

can take the investigational therapies at home so they can be at home with their families, instead of at a clinic, hospital, or doctor’s office. “We’re looking to improve outcomes for the patient but also looking to do so in a way that side effects are well-tolerated by the patient,” says Korfin, noting the oral therapy is easy and convenient for patients to take. They’re continuing to grow the pipeline of these metabolic therapies into 2032, and have 162 patents granted or pending globally. TYME plans to initiate a pivotal trial in third-line pancreatic cancer in the third quarter of 2019. They’re also partnering with the world’s largest patient advocacy group committed to curing pancreatic cancer, the Pancreatic Cancer Action Network, through their Precision Promise™ platform to launch an adaptive pivotal trial using SM-88 in second-line pancreatic cancer in the third quarter of 2019. TYME is eager to pair their approach with other innovative treatments in the interest of helping cancer patients live longer and better lives. “At TYME, we’re very passionate about helping patients with unmet medical needs,” says Korfin. “Our focus is on those difficult-to-treat cancers and targeting the cancer cell and sparing the healthy cell.”n Kristen Castillo MEDIAPLANET • 7

How Today’s Approach to Cancer Care Gives Patients Control We talked to Joan O’Hanlon Curry, M.S., RN, CPNP, CPON®, president of the Association of Pediatric Hematology/Oncology Nurses, about how modern cancer treatments take a holistic approach to care. What do you believe are the most notable advancements in cancer care? The use of chimeric antigen receptor T-cell (CAR-T) therapy to put patients in remission, as either a cure or to allow them to make it to stem cell transplant as a cure, is one of the most notable advancements we have seen in treating leukemia and lymphoma. In addition, the increase in the amount of biologic agents available has increased the portfolio for treatment options for patients. What new practices can be implemented to help improve patient care? Looking at the patient’s whole treatment plan improves patient care, meaning supportive care, spiritual care, along with the medical treatment. It is important to remember that we are treating the whole patient, not just the disease. How has new technology changed the ability to care for cancer patients? I strongly believe the new treatments have provided more options for patients for a cure and even for prolonging life. How do you envision cancer care will change and adapt in the next ten years? I think the push for ambulatory treatments will increase along with the target therapies to attack the disease, but minimize the side effects of treatment. I also see more personalized medicine, meaning that patients’ tumors are profiled at the beginning of treatment so you can find the most effective treatment against the cancer. 8 • FUTUREOFPERSONALHEALTH.COM

The Game-Changing Research That’s Curing Children’s Cancer Research in blood cancer has been ongoing for 70 years, and breakthroughs are happening more quickly now than ever before. “It’s the golden age of cancer research right now,” said Lee Greenberger, Ph.D., the chief scientific officer of The Leukemia & Lymphoma Society (LLS). The LLS is the largest nonprofit funder of cutting-edge blood cancer research for every type of blood cancer, including leukemia, lymphoma, myeloma, and other rare blood cancers. “Something very dramatic is happening because we’ve learned so much about how these blood cancer cells operate,” Greenberger explained. “A lot of drugs have been developed and we know how to develop them.” Since launching in 1949, LLS has invested nearly $1.3 billion in cancer research, which has led to advances in immunotherapy, personalized medicine, and genomics. Since 2017, LLS has helped advance 43 of the 49 blood cancer treatment options approved by the FDA. Their research is also having a significant impact on therapies for other cancers.

The organization has also launched The LLS Children’s Initiative, a $50 million multi-year endeavor, with a bold vision for young patients to not only survive their cancer but thrive in their lives after treatment. Progress “Ninety percent of children diagnosed with acute lymphoblastic leukemia will be cured,” said Greenberger, explaining there’s a lot of progress in blood cancer research as it’s very easy to sample blood or bone marrow, compared to sampling solid tumors. “But many of these children will suffer long-term effects from their treatment, and children who get acute myeloid leukemia have a much lower survival rate. So the need remains urgent to find better treatments.” One of the most exciting advancements is immunotherapy, which uses a patient’s immune system to fight cancer. A promising therapy Researchers have been developing one type of immunotherapy, chimeric antigen receptor T-cell (CAR-T) therapy, for more than 20 years. LLS has invested more than $40

million to advance CAR-T and other so-called adoptive cell therapies. During CAR-T, a patient’s T cells are genetically modified in a lab to recognize and attack targeted tumor cells. The reprogrammed T cells act as a living drug, remaining in the patient’s body months or years after infusion, destroying all of the cancer cells and helping protect against recurrence. “If it can cause cures with a single dose of CAR-T in the worst-case patients, imagine what it can do for patients who are newly diagnosed,” Greenberger said. “It’s an absolute game-changer.” Many blood cancer patients who have received the CAR-T treatment have experienced long-term remissions. One of the first patients to receive the therapy has been disease-free for eight years. With the success of CAR-T, researchers are now trying to use the same approach in solid tumors. “We are confident,” Greenberger said. “If we can cure some of these blood cancers, we can probably cure many of them. It’s just a matter of time, money, and effort.” n Kristen Castillo MEDIAPLANET

Cancer might be tough. But we are tougher. We are The Leukemia & Lymphoma Society. We are leaders in advancing breakthroughs in immunotherapy, genomics and personalized medicine. This research saves lives. Help us save more lives. Donate now at www.LLS.org

How Nurses Will Influence the Future of Cancer Care hematology/oncology nursing has come since then. One of the trends causing a lot of excitement is personalized medicine. Personalized medicine is the customizing of medical treatment to the individual characteristics of each patient. It relies on our understanding of how a person’s unique molecular and genetic profile makes them susceptible to certain diseases. In the world of pediatric oncology nursing, a specific form of personalized medicine — biotherapy — is generating quite a bit of excitement and optimism.

In the ever-changing practice of cancer care, there is always a need for talented, savvy, and compassionate nurses to lend a hand. I remember so well the first professional conference for pediatric hematology/oncology nurses I attended in 2006. I was in awe of the amazing nursing leaders walking around the conference, 10 • FUTUREOFPERSONALHEALTH.COM

giving back to our profession by giving sessions, but still actively learning and helping to drive pediatric hematology/oncology forward. Now, 13 years later, I continue to be in awe of the nursing leaders that attend the Association of Pediatric Hematology/ Oncology Nurses (APHON) annual conference, but also am in awe to see how far pediatric

Targeting cancer Biotherapy is based on understanding how the immune system works, how cells communicate with each other, and how cancer cells interact with each other and with the immune system. In general, there are two types of biotherapy: immunotherapy, in which the host’s immune system is restored in order to control the cancer cells, and targeted therapy, which acts directly on a specific process that the cancer cell depends on for growth. Why are we so interested in biotherapy when chemotherapy and other treatments have generated a childhood cancer survival rate that has improved greatly over the past 50 years? One reason is the relative lack of side effects. Chemotherapy does not discriminate between regular cells and cancer cells; it kills all cells equally, with long-term effects.

Biotherapy is more discriminate; it searches for cancer cells and prevents their proliferation. While there are side effects to biotherapy, they are related to the stimulation of the immune system, not the destruction or suppression of normal cells. There are typically fewer side effects to normal cells and less of a chance of drug resistance. Multi-talented experts Treating children with cancer takes a big team — families, physicians, social workers, and nurses. The nursing role in the cancer experience is a unique one. More than any other group of healthcare professionals, nurses work alongside patients and families to provide care, support, and education throughout the cancer experience. In the world of interprofessional practice, nurses are using relationship and organizational skills to coordinate care across disciplines, departments, and institutions, and serving as expert navigators for patients and families. In this changing healthcare environment, nurses will be faced with many challenges. Innovative t herapies, li ke biotherapy, will have to be combined w it h innovative approaches to support oncology nurses in this emotionally taxing work, in order to minimize compassion fatigue and to retain highly skilled nurses. Funding support for nursing research that emphasizes caregiving research, and team- and self-management will be needed to build even more effective nursing teams in pediatric hematology/oncology nursing. The most wonderful future challenge, however, will be changing our scope of nursing work because childhood cancer will be cured or prevented altogether. n Joan O’Hanlon Curry, M.S., RN, CPNP, CPON®, President, Association of Pediatric Hematology/Oncology Nurses (APHON)

The Key to Improving Cancer Care Among Minority Communities A half-century after America’s Civil Rights Movement exposed gross disparities in healthcare among minorities, the issue still plagues the medical community.

his is particularly true with cancer, which affects all population groups in the United States, yet disproportionately burdens some more than others. The U.S. cancer death rate has declined by 27 percent since peaking in 1991, but not everyone has benefited equally from advancements in prevention, early detection, and treatments. While the underlying complex causes of disparities in cancer care include interrelated social, economic, cultural, environmental, and health-system factors, we also know clinical trial participation (or the lack thereof ) plays a critical role. Trial and error Clinical trials are the most important and reliable means

available to provide the necessary scientific evidence to develop therapies and effective care management for cancer patients. So it’s imperative to ensure all Americans have the opportunity to participate. This is not the case, however. Today, clinical trials often have low participation by racial and ethnic minorities, and people with diverse genetic ancestry, largely because of mistrust of the healthcare system and medical research, a difficult application process, anticipated costs, a sense of fatalism, fear and delays in seeking healthcare, and language and other cultural barriers. Low clinical trial participation makes it more likely that results may not fully apply to all patients.

Maintaining the status quo and allowing the broad chasm between the “haves” and “have nots” in cancer care to persist is unacceptable. Changing the narrative One size doesn’t fit all. Addressing this issue in meaningful ways requires a precise understanding of how minority groups’ perceptions differ, including their respectively unique objections to clinical trial participation.

Taking into account how different minority groups talk about cancer and clinical trials is also essential for raising public awareness and educating patients, their families, caregivers, and the medical community about the importance of diversity among participants in clinical trials. These are undoubtedly complex challenges that will require a total reengineering of how clinical trials are conducted. The alternative — maintaining the status quo and allowing the broad chasm between the “haves” and “have nots” in cancer care to persist — is unacceptable. It’s literally a matter of life and death. n Sung Poblete, Ph.D., RN, President and CEO, Stand Up To Cancer, and Edith A. Perez, M.D., Professor of Medicine, Mayo Clinic College of Medicine MEDIAPLANET • 11

This Is What the Future of Breast Cancer Care Will Look Like

What do you believe are the most notable advancements in breast cancer care? The sheer pace of innovation. With new drug approvals and data about sequencing and combination treatments, we are seeing practice-changing innovations that provide an improved survival benefit. Along with survival benefits comes the need to develop treatments that have fewer side effects. What new practices can breast cancer doctors and nurses implement right now to help improve patient care? As we collaborate with the oncology community, we know how important it is for women with metastatic breast cancer to feel “more like people and less like patients.” This can be accomplished by using communication tools to understand patient goals, providing questionnaires to measure distress, and considering new treatments that balance efficacy and side-effect profiles with patient lifestyles. How has new technology changed the ability to care for cancer patients? IV chemotherapy, which has been foundational in metastatic breast cancer, has significant limitations and side effects. In the past, the ability to take chemotherapy by mouth was limited because the gastrointestinal tract can stop the drug from being absorbed. New drug technology, including drug candidates in our Orascovery platform, may allow patients to receive chemotherapy by mouth, which can help improve the treatment experience. 12 • FUTUREOFPERSONALHEALTH.COM

PHOTO: STU MORLEY

Timothy Cook, senior vice president of Global Oncology at Athenex Oncology, a U.S.based, global biopharmaceutical company, talks about the biggest advancements in how we treat cancer and what he expects to change most in the near future.

She’s Thriving A�ter Bouts With Cancer. Now Olivia Newton-John Is Giving Back Olivia Newton-John has entertained the world for over fıve decades. The singer, actress, and cancer survivor is reflecting on her career in her new book “Don’t Stop Believin.” Newton-John, who turns 71 this fall, was first diagnosed with breast cancer in 1992. It came back in 2013 and again in 2017 when it spread to her sacrum, a bone at the base of the spine. Nine months ago, she fractured her pelvis, a result of weakened bones caused by cancer. “I’m doing great,” she said. “It’s unlikely you ever get rid of it all but you can live with it and that’s what I’m doing.” She’s eating healthy, walking daily, and taking supplements and medicine prescribed by her doctor. She also uses medical marijuana grown by her husband John Easterling. “It’s helped me immensely with everything,” said Newton-John, who used marijuana to wean herself off morphine after her bone break. “I want people to know it’s possible.” She’s grateful for the love and support she receives from Easterling and her daughter Chloe. “I don’t know what I would have done without my family, my husband,” Newton-John said. “They’re supportive and life goes on, and I’m just so, so lucky.” A gi�t The “Grease” and “Xanadu” star takes a positive approach to life and says, oddly

enough, she’s grown from her experience with cancer. “It’s really a gift because it created so many things in my life that I wouldn’t have thought about,” said Newton-John, who’s passionate about wellness for the body, mind, and spirit. She’s the namesake of the Olivia Newton-John Cancer Wellness and Research Centre at the Austin Hospital in Melbourne, Australia. “I have big dreams that we’ll see a cancer intervention in my lifetime,” she said. “That’s my ultimate dream.” Auction Newton-John’s many accolades include winning four Grammy Awards, selling more than 100 million albums, and creating 10 No. 1 hits like “Physical.” Over her long career, she’s collected lots of costumes and other memorabilia. She’s now auctioning off a lot of that swag, with a large percentage of the proceeds benefiting her cancer center. The Julien’s Auction takes place Nov. 1 and 2 in Los Angeles. There are 200 items up for bid, including the black leather jacket and skin tight pants she wore in “Grease,” as well as her original script from the iconic film and a custom “Pink Ladies” jacket the film’s cast and crew presented to her. Bid in-person or online at juliensauctions.com. n Kristen Castillo MEDIAPLANET

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Why Did I Get Prostate Cancer? It Starts With Inflammation

Reducing your risk of prostate cancer starts with reducing your risk of chronic inflammation, which is as simple as exercising and eating right. Inflammation is your body’s own version of Dr. Jekyll and Mr. Hyde: When it works like it’s supposed to — when you skin your knee, for instance — inflammation is good. To fight bacteria and germs that could get into that scraped knee, your resourceful immune cells can spray harmful chemicals on them, puncture their armor, or even eat them whole! Meanwhile, you notice some redness, a little heat, and maybe some swelling or a bruise. Then comes a scab or scar, and all is well — the knee is healed and inflammation goes away. But what if it doesn’t go away? Well, this is the dark side of inflammation — the Mr. 14 • FUTUREOFPERSONALHEALTH.COM

Hyde side. Chronic inflammation is bad. “The story of inflammation is absolutely the heart of what causes prostate cancer,” said medical oncologist Jonathan Simons, M.D., CEO of the Prostate Cancer Foundation. “Inflammation lowers your defenses,” and changes the DNA. “We estimate 30 percent of all cancers are caused by this kind of damage.” Chronic inflammation disables certain genes that normally keep inflammation in check. Then it widens its attack, calling in other immune cells called macrophages and granulocytes to the scene; they’re supposed to be part of the body’s cleanup crew, when the enemy germ or bacteria is defeated. Unfortunately, in chronic inflammation, these cells actually make things worse.

You can reduce your insulin level with exercise. What causes chronic inflammation? One huge cause is our diet, particularly fats, charred meats, processed carbohydrates, chemicals in junk food, and sugar. Basically what we know as the Western diet — high in meat and bad carbs, low in fruits and vegetables. How do we know this? Because the men least likely to get prostate cancer live in rural Asia and eat the traditional Eastern diet — low in meat, high in fruits and vegetables,

and almost no processed carbs. No soda, lots of green tea. No fries, lots of rice. No burgers, lots of broccoli. “The rural Asian diet is anti-inflammatory,” Simons said. The opposite is also true. Obesity and one of its consequences, diabetes, encourage inflammation. “If you are even overweight or borderline diabetic, you turn on more insulin to try to control your blood sugar,” Simons said. Insulin secretes molecules called cytokines, which bring in oxygen, new blood vessels, and nutrients to feed developing cancer cells. “You can reduce your insulin level with exercise,” Simons said. “There’s a lot of evidence that just being sedentary is a terrible setup for trouble later, if you have a slightly inflamed prostate and higher insulin level.” An ounce of prevention What else makes inflammation worse? Cigarette smoking. What makes it better? We’re still figuring this out. A good diet, exercise, and anti-inflammatory agents, like vitamin D, and dietary supplements, such as turmeric, seem to help, as do broccoli and tomatoes. New research suggests probiotics — “good” bacteria that change the microflora in the gut — may also prove helpful in preventing cancer. Could this be related to the link between infection and inflammation? We don’t know. Stay tuned. n Janet Farrar Worthington, Author, Prostate Cancer Foundation MEDIAPLANET

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ECOG PS 0-1 If these key eligibility criteria are met, you may be eligible to participate in our clinical study program. There are additional eligibility criteria that must be met and can only be assessed by a study physician. TIL Therapy is an investigational therapy and has not been approved for any indication by the United States Food and Drug Administration (USFDA) or any other regulatory agency. The safety and efﬁcacy of this therapy has not been determined.