Cancer Series: A personal story and San Diego research making a difference
November 21, 2011 1:15 p.m.
David Cheresh, Ph.D, Director of Translational Research at UC-San Diego Moores Cancer Research Center
Peggy Pico, KPBS Science and Technology reporter
KPBS health and science reporter, Peggy Pico, are is the type of person that usually gets enthusiastic involved in the stories she covers. This time, Peggy got more involved than she ever expected. Several months ago, Peggy was diagnosed and has been undergoing treatment for breast cancer. Today, at a kickoff a special series in which Peggy will not only share her professional expertise but allow us to experience her personal journey. My guest, doctor David cherish, director of translation research at UC San Diego's Moore's cancer research center. Welcome to the show.
CHERESH: Thank you.
CAVANAUGH: And here with us now is Peggy Pico. Welcome, Peggy
PICO: It's good to be here.
CAVANAUGH: Tell us when you learned you had cancer.
PICO: I had a routine mammogram, actually. And they did a couple of them. They couldn't quite see what was going on. So that was back in May. And it was quite surprising because nobody in my family's had cancer ever. We're Italian. We all get heart attacks. So cancer was quite a surprise.
CAVANAUGH: A lot of people may not know you're also a nurse. How does your professional background affect your understanding of the disease and the treatments you've been going through?
PICO: I was an OB nurse, so definitely into women's health. I did that for ten years, and it certainly influences it. I'm very aware of sort of the medical process, and sort of how things work in the hospital, and how treatments work. But also my years as a medical journalist, and doing tons and tons of research and looking at research. So it certainly impacted he.
CAVANAUGH: Has it influenced any of the choices you've made about your treatment?
PICO: Absolutely it has, probably to the chagrin of my doctors and nurses. I wanted research, data, percentages. I opted out of one treatment because I felt the risk benefit wasn't quite right for me. So it was very personal, and using my background absolutely made me decide on some different treatment options.
CAVANAUGH: Are there times that you wish you didn't know as much as you do know about the way, you know, the medical world works and about your specific disease?
PICO: Yes. I -- like I said, I poured over every bit of research, and one of the things that somebody ask said me, when you're done with this, what is the first thing that you're going to be relieved about? And my answer was I'm so tired of making life and death decisions. I looked at every bit of research, oh, you have a 30% survival rate if you do this, but if you do this, it drops to 15, but if you add this, it brings it back up to 20. And going over all this data and trying to make what I felt to be life and death decisions that gambling with treatment options that -- you've only got the data. It was very tiring. And sometimes I wish I had been more like some of my friends who have had cancer who are, like, they're your team coach! Go with everything they say! I'm sure my doctors would have liked that too. I kind of processed it every step of the way and every two weeks with chemo, that can get exhausting. It was a little bit exhausting, but I'm the kind of person who needs to know every last bit of detail.
CAVANAUGH: I want to invite our listener fist they'd like to chime in with their own experiences or like to ask you a question, our number is 1-888-895-5727. One last question. And what surprises you most about living with cancer?
PICO: The first thing that surprised me was the overwhelming accept apse and supporter. And I think living with cancer is the key. It wasn't like this death sentence, you know? It was -- wow, and cancer is not just breast cancer. Obviously there's a ton of supporter for that, public support. You see football players wearing pink. But throat cancer, brain cancer, pancreatic cancer, I was so surprised to see so many people surviving, and on top of that, professional supporter. The doctors at UC Moore's cancer center were amazing. I did both traditional treatments and integrative. Accue puncture, meditation, and everybody here in San Diego seems quite -- oh, yeah, you've got cancer, here's what you do. And I can't tell you how helpful that was because I thought I didn't need it. I thought as a nurse and a journalist, I have all the information. I don't neat all the support. And I absolutely did, and it was key to recovering.
CAVANAUGH: Doctor David cherish, you are director as I said of the translation research at UC San Diego Moore's cancer research center. Can you tell us what translation medicine is?
CHERESH: Yes. It's the conversion of some of our scientific discoveries into clinical practice and use.
CAVANAUGH: I see. So in other words they make a breakthrough we hear about in a headline, and you try to figure out how to actually use that to help patients
CHERESH: That's right. We bring teams of scientists, engineers, physicians, chemists, biologists together to try to figure out what the problems are and then convert some of those discoveries into clinical trials, and opportunities for cancer patients going forward
CAVANAUGH: Where would you say San Diego stands in comparison to other cities in regards to other retch and in clinical applications as well?
CHERESH: I like to think that we're really a hub of cancer research. Not unlike two other cities, Boston and San Francisco, where you have this tremendous infrastructure of basic clinical research as well as the biotech sector all pulled together. We have several hundred companies in town, many of them focus on cancer, many of them focus on discovers made at our cancer center.
CAVANAUGH: What part does that play in the number of treatment options available to patients here in San Diego?
CHERESH: Many of our scientists are always physicians. And they work today by side with the basic researchers, with the biomedical scientists, to bring some of their discoveries into the clinic. So they understand the disease in a rather unique way. They understand it both from the clinical perspective, and also the basic scientific perspective.
CAVANAUGH: Doctor Cherish, we hear so much about cancer research, and the different directions it's going, DNA, special targeted medicines to your own genetic makeup, different drugs that would come. What is the current focus of cancer research?
CHERESH: Well, there are a number of different fronts. I think we're making progress in put pel areas. And this includes as you suggested, the concept of getting genetic information, not only about the cancer patient but about the tumor that cancer patient has. In other words, we're getting jenommic sequence information that helps us predict whether a given patient with a particular tumor type will respond to a given therapeutic regiment. We're also seeing no approaches to delivered therapy. Part of the problem with cancer treatment is that -- is not that we can't kill tumors, it's how do we get the drug to the tumor while sparing normal tissue? One major development issue is nanotechnology where we've developed new approaches to bring payloads of drugs to the tumors in there sparing normal tissue.
CAVANAUGH: And how does this translational medicine translate into your treatment options?
PICO: It absolutely did from day one. One of the things that happened, they -- before I even biopsied, they were testing it, genetically, very specific. And now you don't have to wait for the research to hit you is they took that and were able to tell me what kind of chemo I needed versus what kind I didn't, what kind of follow-up medicine I needed. If I could participate in some clinical trials or if not. I think the genetic side, I was quite surprised about how individual -- that's the translational medicine, it makes it possible to be very individual. And even though I got tired of hearing it, they're, like, oh, well, everybody's different of the but everybody is different. It was like treating your own specific car with its specific problem rather than saying let's treat all Toyotas the same, let's say. So I was amazed at how individual and different it was
CAVANAUGH: We hear a lot in San Diego about our biotech industry. And BioMed industry, really. And I'm wondering, you touched on it before, doctor cherish, but what part does the biotech industry play in cancer research here in San Diego?
CHERESH: So the biotech industry really takes the discoveries that not only we do, but others do in the cancer area and help develop the drugs that the patients actually need. And then we can in many cases bring the drugs back into our center to test those. So some of the scientists that are actually involved in the initial discovery are engaged in working closely with the private sector to help the drug for clinical use. And then they bring it back in and assemble a particular trial for a subpopulation of patients
CAVANAUGH: As I said, we are taking calls for listeners who want to talk to both of you. Our number here is 1-888-895-5727. Sean is on the line from Carlsbad. Welcome to the show.
NEW SPEAKER: Thanks. I have a quick question now on what does diet affect -- diet and exercise on cancer prevention and treatment, specifically reducing animal protein, referring to the China study and reducing your glycemic index.
CAVANAUGH: I'm going to throw that out to both of you. There's one that's living it, and one that's studying it. Doctor cherish?
CHERESH: I'm not sure that's an easy question to answer. And I think it really -- there are a lot of components that go into whether a patient ends up with cancer at the end of the day. Certainly we've heard about the genetic predisposition. Certainly families have it. We know that diet plays a crucial role. Exercise, well being over all, certainly stress, anxiety, hormonal disregulations and stress can clearly be associated with a number of cancer types. If you can reduce stress levels, you can certainly mitigate the potential for cancers to develop. Or you may even impact the way certain therapies inhibit the tumor you do have. But I think the jury is still out on precisely what role, say, dietary fat might have. It certainly has been linked to cardiovascular problems and other things. But I think we have perhaps better evidence for what cigarette smoke might do than we may specifically have about a given diet
PICO: Yeah, and Sean, so I -- UCSD, my doctor sent me to a nutritionist and a dietician, not only to help get through the chemo. While you're going through chemo. There's different things you have to worry about as far as your digestion and I didn't get to eat some of the anticancer vegetables, broccoli and things like that, that are pretty high on the list on these anticancer diets. What I've learned from my reading, and I really read all throughout, waiting till I could eat again, was that there's this idea of terrain dieting, and sort of getting the terrain, the inflammation low in your body. That being said, and I'm an advocate of healthy eating, I have friends that were just the picture of health, you know? Literally grew up in a health food store, ate perfectly, exercised, they got cancer too. Ive wasn't the best at my dediet, and I got cancer. So I think a healthy diet is excellent. I think it can only improve your health. But I would agree with doctor cherish. I think the jury is still out on if it can actually prevent a tumor from growing.
CAVANAUGH: You must get so much unsolicited advice from about what to eat, what to do, what not to do when it comes to the food and the liquids you ingest. What is the most project thing you hear from people?
PICO: What I should and shouldn't do? Well, right off the top is not to drink. So that's a bummer because I really like martinis. But it seems to be there's a theme in medicine not just with cancer, but cardiovascular disease. You were talking about this apartment inflammatory, eating foods that keep inflammation down in your body. Yeah, I've had all sorts of different advice on how to handle it. Again, very individual. But certainly maintaining good nutrition. I lost some weight on my chemo. And it was the first time in my life, you know, a physician was not happy with me for losing weight. They're like no! You need your protein! You need your muscles! Eat! So yeah, lots and lots of advice.
CAVANAUGH: Doctor cherish?
CHERESH: So certainly things like obesity have been linked to certain types of cancers, for example. But I would also argue that diagnosing cancer earlier makes a big difference. So independent of what your diet might be, I think if we have better approaches to identify cancers on a more routine basis, a lot of the research going on in the cancer doctors to identify markers in the blood, are the urine, that might give us a tip that there's indeed a cancer on board. And I think those are important pieces of the puzzle. If we detect the cancer earlier, most of the cancers are treatable. And the real problems are the one that haven't been diagnosed early enough to effectively treat them
CAVANAUGH: As I said, we are taking your calls at 1-888-895-5727. Let me introduce my guests. I'm speaking with doctor David cherish, director of translation research at UC San Diego Moore's cancer research center. And our own health and science reporter, Peggy Pico is talking with us about living with cancer. She was diagnosed with breast cancer several months ago. Barbara is on the line right now. 1-888-895-5727. %F01
NEW SPEAKER: I'm a 15-year breast cancer survivor
NEW SPEAKER: Unfortunately, I've had three lumps in my breasts that I'm concerned about. Of it's in the same breast. I did manage to have a mammogram and an ultrasound done. And they did come back negative. Now, on the bottom of the test results, it said that I need -- just because it says that the test came out negative, that it doesn't mean that I don't have cancer. And they're suggesting getting a -- an MRI. And I was wondering what your opinion on that.
CHERESH: Well, I'm a researcher more than a treatment type of person. But my recommendation certainly would be to follow up with an MRI. An MRI can certainly detect -- if you know that you're looking for a particular disease. But certainly see your physician and make sure you're checked out very thoroughly at this point. There's a certainly opportunity that maybe these are just jumps that aren't problematic
PICO: And my mammogram was a little inconclusive at first. And we found bon or two lumps. I I went on to have an MRI, Barbara, and they found another 6 or 7 lumps that couldn't be picked up on the MRI. So if it's something that you can do, it certainly picked up tumors and certainly gave the exact size of my tumors on the MRI that the mammogram and even the ultrasound couldn't find
CAVANAUGH: Allison is calling us from San Diego. Good afternoon, welcome to the program. %F01
NEW SPEAKER: Thank you. Last year, my niece was diagnosed with AML. And just following her treatment and everything, all the way through to the bone marrow transplant, it just seems like the treatment for cancer is so barbaric and hash in comparison to the treatment for cancer for adults. It seems like there's not a lot of -- as much money spent on childhood cancer, especially breast cancer. I was just wondering about the strides made for that.
CAVANAUGH: Well, thank you, and I'm going to give that to doctor cherish.
CHERESH: We have recently, in fact, formed an alliance with Reidy children hospital. In particular, we've been recruiting physicians, 1269s who are pediatric oncologists. Doctor Donald durreden, who was brought in specifically to work across this problem and this gap. And the question is how can we take what we've learned about adult cancers and apply them to the pediatric population? So what doctor Durden, and others at the cancer center, and together with Reidy children's hospital, and wee begun to formulate a team to find drugs that perhaps are useful in adult cancers that haven't yet been placed into the pediatric population
CAVANAUGH: So much has changed in cancer research over the last decade. What still needs to be changed? What do you see on the horizon that would really make a big difference in the treatment of different sorts of cancers?
CHERESH: One of the things requesting on now, we're identifying that each cancer patient is really quite an idea. We may have up to 100 different kinds of breast cancer or over 100 type was lung cancer. As we begin to identify the specific signatures of those cancers, whether they be biochemical or genetic, we can begin to identify the treatments. I'd give you an example. I'm aware of a clinical trial for brain cancer that initially when the drug was tested, it didn't look like it was effective until later the patients were broken down based on a particular genetic marker, and it was found that the drug had an exceptional activity in one subpopulation of patients. So what happened was that that drug was then used to treatment only those patients in subsequent clinical trials. And in fact, that's the direction I think not only for that particular drug, but we're seeing that in many examples where individuals are being identified based on some of the scientific discovery work going on not only in our center, but around the country, and we're beginning to identify those categories of patients that really have the genetic and biochemical markers to justify a particular therapy
CAVANAUGH: And Peggy, you were saying that you've already had some of that in that your treatment is really being targeted to your own genetic makeup.
PICO: Absolutely. For instance, my tumor is estrogen positive. It was this thing called HER2 negative which is a protein on a cell. Originally they thought it was positive, which would have meant different drug enforce me. Once they founds out it was HER2 negative, it category so targeted. And the way I like to put it to people, it seems like treatment in general used to be -- I'm coming back to the car analogy. If you took a park parking lot and said all white car vs a problem. Then they realized oh, well, you can't just fix all white cars, it's specific to the type of car it is. So we're going to fix all Toyotas that are white because they have a problem, let's say. Not that they do. And then finally, it's like now they would say, no, you can't just say pause your car is a white Toyota, it's going to have in problem. It's your individual car. You take it to your individual mechanic and get your individual car looked at and fixed. And that's what it seems like cancer research has changed the treatment options. And it did with me.
CAVANAUGH: When we talk about cancer research, some of this is pure science and the doctors and the researchers like to get, you know, work on it, and work on it, and work on it. But when we hear about a breakthrough, we hear about a breakthrough in cancer research, you have a phrase, Peggy, you use from lab bench to bed-side treatment. What's the time frame on that?
PICO: Well, what would it be for, let's say, today you discovered something, doctor cherish on treating Brett cancer. How long would it take to maybe get a good drug?
CHERESH: Good question. I would say 20†years ago, it was about 10 to 15†years.
CAVANAUGH: Right, yeah.
CHERESH: I've been involved in discoveries that now, 15 to 20†years later are just answer entering the registration phase of clinical trials. But what has happened over the last, say, ten years, based on this idea of understanding how specific cancers respond and picking the right patients to begin with, we can then home in on those patients. And earlier in the clinical development, we can see responses. It used to be you did a clinical trial that was purely designed to see safety. Now we're beginning to look a little more at efficacy earlier on. And there are some trials that are moving very quickly as a result, and some drugs moving true at 1/3 the length of time. Because we're picking the right patients. We know more with those cancers and the individuals who are on the trial, and we are expecting to see proof of concept as early clinical trials as opposed to the later ones.
CAVANAUGH: Let's take another call. Tom is calling us from Oceanside. Hello, Tom, thanks for staying on the line.
NEW SPEAKER: I was wondering if EVista southbounds like a good preventative option. Some of the trials look pretty good with that. And also statins.
CAVANAUGH: Doctor cherish?
CHERESH: I'm not sure what the first 1 was. I've heard about --
CHERESH: Yeah, but with regard to the statins, I know there's been a lot of discussions and controversy. And im-- not sure that the jury's made any recommendations yet. These are -- the concern that I think we run into is when you have sort of dietary supplements, it's a very difficult thing to monitor because you're dealing with large patient populations and looking at this mixture of patients, and it's very hard to discern whether a particular change in a dietary supplement or something like a lipid lowering drug may have in a particular area. It may do very well but not so well on another particular cancer. It may be difficult to ascertain
CAVANAUGH: I'm wondering, there must be people listening to our conversation here now who are wondering about the clinical trials for cancer under way in San Diego. How do people find out about those?
CHERESH: There's a couple ways. Go to the Moore's website, and it'll break the cancers down in terms of the category. And you can also go to the NIH.govwebsite, that lists all the clinical trials ongoing. So there's a wealth ofinformation available. And we work through the national cancer institute to test many of the drugs that are part of those trials
CAVANAUGH: And are you going to be involved in any clipical trial, Peggy?
PICO: Oh, I already have. Because it's so specific now, I actually wanted to be in one that was a joint clinical trial between UCSD Moore's and UCSF. About you they tested my tumor, and it wasn't the exact -- it wasn't the type of tumor it needed to be. So what I did instead, there's lots of mini-ongoing trials, one that I participated in which was just actually really cool was -- it only took, like, two-hour, but it was a new way to detect breast cancer instead of using a mammogram. You put your breast into this tube or bucket of warm water, and ultrasound went through it, other and it took a picture of your breast. So instead of getting squished in a machine, this was trying to see if it could give a very clear picture. I got to see the picture. It looked clear to me. And of course I'm not a radiologist. But the thing I found helpful is even if you can't participate in the big NIH, or the UCSD cancer center's big, big trials, there's lots of mini-trials that you can do that may just require a blood or urine test.
CAVANAUGH: Our audience cannot see you. They will be able to see you tonight if they watch KPBS evening edition at 6:30. But here you are, you're looking gorgeous, lost your hair because of chemotherapy. How are you feeling?
PICO: I feel better each day. The chemo they have so many medications now. That's something that surprised me as well. I feel better each day to answer to that question. But they have so many drugs now that I never once threw up in my treatment. I haven't lost weight. I was hoping I would as a byproduct of this, but no. So it's amazing, the -- how they're able to manage the side effects. Of course there's still fatigue. I still had stomach issues, although it wasn't the nausea and vomiting.
CAVANAUGH: Right. So you're feeling a little stronger each day?
PICO: Stronger each day. Yeah, it takes -- I went in every two weeks, so as awe start to get feeling back on your feet, then you get blasted with another one. But that's to really knock out everything. I'll be good as new by the new year.
CHERESH: I was going to say that what's on the horizon for patient like Peggy are drugs that are not -- with the intense side effect nas we've heard about. And I think if we combine this new targeted approach with new ways of drug delivery, we're going after specific pathways and tumor cells that are not found in normal cells. And I think as we learn more about the cancer cell in particular. Of and that's what our scientists at the cancer center are really very good at, is understanding those peculiar things about the tumors that are different than normal cells. We can attack those very peculiar pathways. And in doing so, not affect the normal cells like hair follicles, and the GI tract, and the kinds of things that cause the visible and physical side effects that we're all very familiar with.
CAVANAUGH: I want everyone to know that Peggy will be joining us in an ongoing series as we continue to explore cancer research. And as I said, be sure to tune in tonight to see Peggy Pico and doctor David cherish on KPBS evening edition, tonight at 6:30 on KPBS TV. And thank you both so much for speaking with us
PICO: Thank you.
CHERESH: Thank you.