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How new drugs become available to more patients

Filling in the unknowns on the balance between risk and benefit

Feb. 9, 2018 | by Susan Keown / Fred Hutch News Service

Graphic illustration showing a scale with people, medications and question marks balanced on each side

Often, a new drug is only approved to treat patients with advanced disease. Why? It's a matter of risks and benefits. With continued research, wider availability can follow.

Illustration by Kim Carney / Fred Hutch

Change is coming in cancer treatment. Last year, the U.S. Food and Drug Administration approved its first-ever engineered cell therapies for cancer, which involve genetically reprogramming patients’ T cells to aim the power of their immune systems squarely at their cancers.

Both of these new therapies are approved only for people with certain advanced cancers who have been failed by multiple conventional treatments, like chemotherapy. Some people may wonder: If these treatments are so promising, why aren’t they available for more patients, including those who have just been diagnosed?

The short answer: We are not yet sure if the benefit outweighs the risk for patients at earlier stages of disease.

If these new treatments run a course anything like many other cancer therapies, however, they may eventually move up to the frontlines of therapy. What would it take for that to happen?

Let’s take a look at the longer answer: how research can fill in the unknowns, shift the balance of evidence and make a new therapy available to more patients.

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Dr. Steve Pergam receives Dr. Ali Al-Johani Award

An expert in infection prevention who is also a 'passionate patient care advocate and an outstanding physician'

Feb. 7, 2018 | By Mary Engel / Fred Hutch News Service

Drs. Nancy E. Davidson and Steven Pergam

Oncologist Dr. Nancy E. Davidson, director of Fred Hutch's Clinical Research Division, presents the Dr. Ali Al-Johani Award to infectious disease physician-researcher Dr. Steve Pergam.

Photo by Robert Hood / Fred Hutch News Service

Dr. Steven Pergam, an infectious disease physician-researcher at Fred Hutchinson Cancer Research Center and medical director of infection prevention at Seattle Cancer Care Alliance, has received the 2018 Dr. Ali Al-Johani Award, which recognizes exceptional medical care and compassion to transplant patients and families.

“This was the world’s easiest task for the selection committee,” said Hutch Clinical Research Division Director Dr. Nancy E. Davidson, who presented the award to Pergam on Tuesday. “We had a dozen nominations for you, all of them extolling your virtues as a physician.”

Awardees are nominated by their fellow caregivers and chosen by a committee that includes the clinical research division director and representatives from nursing, clinical faculty, and quality and patient services. Pergam is the 15th Fred Hutch physician-researcher to receive the award and the first infectious disease specialist to do so.

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Flu season tips for cancer patients

It’s bad out there. Here are 7 things you need to know to protect yourself — and others

Feb. 6, 2018 | By Mary Engel / Fred Hutch News Service

Peggy Sherlin gets a flu shot from registered nurse Nancy Johnson

Peggy Sherlin, a former employee of the Patient Family Resource Center at Seattle Cancer Care Alliance, got a flu shot from registered nurse Nancy Johnson at the Fred Hutchinson Cancer Research Center campus in Seattle. Not only should cancer patients get flu shots, their families and caregivers should too.

Fred Hutch file photo

Flu is miserable enough for someone who is otherwise healthy. It can be devastating for people whose immune systems have been weakened by cancer or treatment or both.

With flu dominating the headlines, we asked two infectious disease specialists at Fred Hutchinson Cancer Research Center how cancer and other immunocompromised patients can protect themselves from infection and what they should do if they get sick.

Here are seven things you should know — whether you are the person with cancer or anyone in that person’s orbit. (Yes, family members, friends, co-workers and care providers with healthy immune systems can take steps to protect those without.)

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‘Waistbands’ of our chromosomes marked by unusual X-shaped DNA

Human Y chromosome’s center more ‘monkey-like’ than other human chromosomes, study finds

Feb. 2, 2018 | By Rachel Tompa / Fred Hutch News Service

An illustration showing two chromosomes in cross stitch, with their centers marked in different colors, on a fabric background with a needle on the side.

A new study has found that the midpoints of chromosomes may be marked by unusually shaped DNA, like a tiny row of cross stitches.

Illustration by Kim Carney / Fred Hutch News Service

For much of biologist Dr. Steve Henikoff’s career, a scientific conundrum has plagued him.

The centromere, the midpoint of our chromosomes that’s essential for cell division — and thus for the very essence of life — remains largely mysterious. Until recently, we didn’t even know what DNA sequences made up centromeres.

And scientists who study these chromosomal waistbands, as Henikoff does in his Fred Hutchinson Cancer Research Center laboratory, don’t fully agree on what defines a centromere.

Some think it’s the region’s DNA sequence, that the centromere bears a genetic ID tag. But most in the field are convinced that DNA has little to do with it, Henikoff said. The prevailing scientific dogma is that our centromeres are defined by something outside of genetics, a phenomenon known as epigenetics.

Henikoff and Sivakanthan Kasinathan, a Fred Hutch and University of Washington graduate student, have come up with a third theory, which they describe in a study published last week in the journal Molecular Biology and Evolution: DNA gives centromeres their identity, but it’s not the precise sequence of letters of the DNA that counts. It’s the shape they make.

Their study presents evidence that DNA at the centromere does not form the standard double helix twist, but rather kinks into a series of small, repeated X-shapes — like a row of cross-stitches.

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When bad bugs jump from farm to bedside

‘Big Chicken’ author, infectious disease researchers take aim at antibiotic resistance driven by agriculture, medicine

Jan. 26, 2018 | By Mary Engel / Fred Hutch News Service

Farm to bedside symposium panel of infectious disease researchers

Infectious disease experts from around the state gathered at Fred Hutch Thursday for a 'Farm to Bedside' symposium on how the overuse of antibiotics in animals can lead to antibiotic-resistant bugs in humans. Panelists from left to right: Drs. Scott Weissman, Douglas Call, Peter Rabinowitz, Marisa D'Angeli and moderators Steve Pergam and Paul Pottinger.

Photo by Robert Hood / Fred Hutch News Service

On Christmas day in 1948, a scientist walked into his laboratory outside of New York City to check the results of an experiment. What he found changed the way we raise farm animals  and, according to journalist and author Maryn McKenna, set the world on course for crisis.

That crisis is antibiotic resistance, and it began — or at least accelerated — with the discovery 70 years ago that McKenna, the author of “Big Chicken: The Incredible Story of How Antibiotics Created Modern Agriculture and Changed the Way the World Eats,” described Thursday to a packed auditorium at Fred Hutchinson Cancer Research Center. 

That scientist discovered that giving tiny doses of antibiotics to chickens sped their growth and protected them from crowding and other unhealthy conditions. Considered both a miracle and a moneymaker, the practice quickly became widespread in pork, beef and other meat production as well. But McKenna said the unintended consequence was that the pervasive use of these drugs put pressure on bacteria to do what they do very well even without encouragement — develop resistance through mutation.

“Whenever we use an antibiotic, we’re taking a risk that the bug will mutate and adapt to the drug designed to kill it. We balance the benefit of the drug versus the risk of resistance,” she said. “Whenever we give animals that are not ill antibiotics, there is no benefit, only risk.”

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How cancer survivors are teaching researchers — even decades later

Tracking survivors long after treatment ends helps inform medical decisions for today’s patients and much more

Jan. 26, 2018 | By Rachel Tompa / Fred Hutch News Service

Dr. Paul Martin

Dr. Paul Martin is former director of Fred Hutch's Long-term Follow-up Program for bone marrow transplant survivors.

Photo by Robert Hood / Fred Hutch News Service

[Editor's note: We've updated this story, originally published in January 2017, to reflect that findings from one of the studies were recently published in the Journal of Clinical Oncology.]

For many years of his career, Dr. Paul Martin had a standing annual tradition. In the days leading up to the New Year’s, he’d sit down and pore over a thick stack of comments from his patients.

As former director of Fred Hutchinson Cancer Research Center’s Long-term Follow-up Program, or LTFU for short, Martin oversaw the team that tracks and follows every patient who’s received a bone marrow transplant through the Hutch. Some of the survivors — who number in the thousands — are 40 or more years out from their transplant at this point.

Every year since its inception in the early 1980s, the program sends out a detailed questionnaire to every transplant survivor. The answers to these questions inform a host of research topics on the long-term effects of transplantation, from graft-vs.-host disease to cataracts, from secondary cancers to infertility and sexual dysfunction.

When Martin became the program’s director in 1999, he added a question to the end of the questionnaire, asking simply whether there was anything else the survivors thought the physician-scientists and other clinicians should know about their experience.

There was a lot, it turned out. So much that Martin needed to take several days over the winter holidays to read through each year’s worth of comments.

“It’s a ton of work. It’s very emotional. I just remember being completely drained after reading them all,” said Martin, who stepped down as program director in 2014 but continues his survivorship research at the Hutch. “There’s incredible joy in some comments and incredible pain in others.”

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