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COMPOUNDING CARE
Clinical trials, new treatments and expanded care options give North Carolinians stronger weapons in the battle against cancer. The result is increased life expectancy for many patients.
A cancer diagnosis can be devastating, both physically and emotionally. Even treatable forms of the disease often take months to stabilize, and depending on its stage, the treatment patients receive can diminish their quality of life, even if they ultimately survive.
Integrative oncologist Dr. Chasse Bailey-Dorton brings a lot to her FirstHealth of the Carolinas practice in Pinehurst. That includes a dose of empathy. She was diagnosed with breast cancer at age 39 and underwent surgery, chemotherapy, radiation therapy and endocrine therapy.
“Nobody knows what it’s like to deal with cancer unless they’ve been through it,” she says. “I was drawn to this field first to help myself and ultimately to better help my patients.”
Bailey-Dorton works alongside other FirstHealth oncologists, providing supportive care for cancer patients and helping them deal with treatment, side effects and recovery. “Integrative oncology is a field of cancer care where we bring in evidence-informed therapies, empower our patients, making them active participants in their own care and ensure they receive the best outcomes possible,” she says. “For me, it’s giving back. You know, there’s a great benefit for us survivors to help other survivors through their journey.”
With a family medicine certification, Bailey-Dorton pursued advanced training in integrative medicine through a fellowship at the Andrew Weil Center for Integrative Medicine in Tucson, Arizona. She was chief of integrated oncology at Atrium Health’s Levine Cancer Institute in Charlotte before joining FirstHealth last year. She is also the founding medical director at The After Cancer, a digital consulting service.
Integrative oncology is a service usually seen in larger healthcare systems. But as an offering available through FirstHealth, which serves residents living in 15 mostly rural central North Carolina counties, it is an example of how oncology is changing in North Carolina. There are more options for treatments, and care is closer to more residents. And opportunities to enroll in clinical trials abound, giving patients the chance to help create future treatments and possibly a cure for the disease, which N.C. State Center for Health Statistics says will lead to 22,607 deaths in North Carolina this year.
PROVIDING OPTIONS
Dr. Ashley Sumrall is neuro-oncology section chief at the Levine Cancer Institute. She started seeking permission from its trial team to open a promising trial for patients with diffuse midline glioma with a H3K27M mutation — a rare and deadly form of brain cancer that primarily affects children and young adults — about eight years ago. “This DMG is characterized by a specific genetic mutation that promotes gene expression and drives tumor growth,” she says. “Patients with this type of glioma typically have a poor prognosis with limited therapeutic options.”
Sumrall’s work focuses on a drug sold under the brand name Modeyso, which she helped bring to market through clinical trials. It received FDA accelerated approval in August as the first systemic therapy for this form of brain cancer.
“Every neuro-oncologist dreams of helping a drug make it through FDA approval,” she says. “What a joy it was on behalf of patients and their families to learn that the FDA said yes to this new therapy.”
EXTENDING LIVES
While breakthroughs in brain cancer treatments are making people optimistic for the future, treatments for other types of deadly cancers are already making a difference in patients’ lives. The median survival rate for multiple myeloma patients was about four years after diagnosis when Dr. Jonathan Serody started his medical career about 30 years ago. “Today, thanks to exciting new treatments in the pipeline, the median survival rate is close to 11 years,” he says. “There is even a group of people who are in stringent complete remission and going for a long period of time without any evidence of active disease or negative impact on their lives.”
Serody is the Elizabeth Thomas Professor of Medicine, Microbiology and Immunology at UNC Lineberger Comprehensive Cancer Center in Chapel Hill and leads its Serody Laboratory. He pioneered the use of RNA genomics to study the tumor microenvironment and directed the creation of UNC Lineberger’s Advanced Cellular Therapeutics Facility, which has grown into one of the nation’s largest and most productive programs of its kind.
In less than a decade, Serody’s program has developed and launched nearly 20 clinical trials using novel Chimeric Antigen Receptor T cell therapy, an immunotherapy that harnesses a patient’s own immune system to fight cancer. “Fifteen years ago, it became pretty clear to many of us that the next wave of cell therapy was CAR T cells or other types of adoptive cell therapy using a patient’s own cells,” he says. “We know the immune system can kill cancer cells, and this has led to the rise of immunotherapy in treating cancer.”
FDA approved CAR T cell therapy to treat some blood cancers, including leukemia, lymphoma and multiple myeloma. Clinical trials are underway to study its effectiveness in solid tumors. “The changes in treatments and life expectancy and outcomes for people with melanoma, lung cancer, kidney cancer and neck cancers have extended their lives from months to years,” Serody says. “With CAR T and other immunotherapies, we can cure about two-fifths of young patients with relapsed acute lymphoblastic leukemia through the use of T cells and antibodies that activate the immune system.”
FINDING CURES
Dr. Peter Voorhees is researching novel therapeutic strategies for treating multiple myeloma. He is a specialist in hematology and internal medicine at Levine and is the associate director of clinical research for Atrium Health Wake Forest Baptist Comprehensive Cancer Center in Winston-Salem.
An expert on the CAR T cell therapy cilta-cel — a treatment for relapsed or refractory multiple myeloma — he has presented and published extensively on its effectiveness and durability, highlighting its long-term benefits, potential for extended remissions and role in managing the disease.
Last summer, Atrium reported on a clinical trial led by Voorhees that resulted in what was called a major step forward in finding a cure for a historically incurable cancer. “At Levine Cancer Institute, we had the good fortune of participating in the first nationwide study of cilta-cel for patients with relapsed or refractory multiple myeloma,” he says. “This was a group of patients who had been treated with the usual therapies, and their disease had become increasingly resistant, and they were running out of options.”
Historically, progression-free survival of relapsed or refractory multiple myeloma is less than six months and overall survival is approximately one year. Of the patients who elected to participate in the study, 98% saw a response to the therapy; a third of them went into remission. “With just a single cilta-cel infusion, we’re showing that at five years and beyond, 33% of patients are alive and disease-free, which is unprecedented in this field,” Voorhees says.
EXPANDING TREATMENT
While large healthcare systems and universities, such as Atrium and UNC, are undertaking cutting-edge research in North Carolina’s biggest cities, the state’s rural communities are seeing more cancer-care options from small systems such as FirstHealth and New Bern-based CarolinaEast Health System.
They depend on organizations such as Southeast Clinical Oncology Research Consortium and the National Cancer Institute Community Oncology Research Program. They offer access to research and clinical trials and provide resources, information and funding for cancer research and programs.
SCOR, which is also supported by the National Cancer Institute’s work, is a membership organization covering more than 20 communities in six Southeastern states, including North Carolina. It offers more than 150 clinical trials for many types of cancer. “We have a responsibility to our patients to provide the same quality of care here that they would receive in a metro area,” says Dr. Charles Kuzma, FirstHealth hematology and oncology specialist.
Kuzma says FirstHealth chooses clinical trials based on the cancers its physicians are qualified to treat. Most are geared toward patients with lung, breast, colorectal or gynecologic cancers. “It’s important for a community healthcare system to have access to clinical trials, and some of the trials we have participated in over the last 15 years have led to FDA approvals and significant advances in cancer treatment,” he says. When he arrived at FirstHealth 17 years ago, the hospital had just one active trial. There are now 40 with more than 100 patients enrolled today.
Patients from a five-county region south and east of New Bern can draw from the expertise of CarolinaEast’s SECU Comprehensive Cancer Center specialists in chemotherapy, radiation therapy and surgery. CarolinaEast Radiation Oncologist Dr. Seth Miller says the hospital participates in clinical trials through SCOR and NCICORP.
“We currently have an open trial that covers radiation treatment regimens for high-risk prostate cancer,” he says. “We’re also looking at a radiation trial for small cell lung cancer in hopes of eradicating the disease and giving patients a longer and more normal life.”
Patients benefit when they can receive clinical trial therapies close to home. “SCOR and NCICORP have opened avenues of care by providing these studies locally, so residents don’t have to travel to the Triangle or beyond for treatment,” Miller says. “This is an evolving landscape in clinical research where some studies can serve patients in local communities.”
Miller points to partnership opportunities with larger hospitals, where patients can start their treatment there then return home to complete it. “We have a local patient enrolled in UNC’s CAMARAN breast cancer study, and she’s able to be treated here in New Bern,” he says. “This is really convenient for her, because she likely would not have participated in the study if she didn’t have the option to get her treatment at home.”
Bright spots in patient care are giving cancer specialists hope and inspiration, even when dealing with some of the most devastating patient diagnoses.
Levine’s Sumrall finds her work inspiring and energizing when she searches for the positives in terminal disease. Even helping patients in small ways, such as preventing headaches and seizures, setting goals and achieving them, or making it to a milestone event, is encouraging. “I met a patient recently who has set the goal of attending her child’s wedding, and that told me what is really important to her,” she says. “I believe that even if we can’t help people live longer, we can help them maintain their dignity and continue setting goals for themselves, and I find it an honor and a privilege to do that.”
Serody acknowledges that there are hard and disappointing days.
He has witnessed the grace patients demonstrate when they face a difficult road ahead and acknowledge that while they won’t be cured, they hope findings from their experience will help others in the future. As a young medical school student in the 1980s, he had dreams of working on cures for cancer, and his work is living up to those dreams. “Our progress in curing disease is built on the progress researchers and physicians made before me, and I see the young people who are building on the research of my generation,” he says. “I don’t know if we’ll cure cancer in my lifetime, but I think we can cure it in my kids’ lifetime or at least make it treatable so people can live full lives.” ■
— Teri Saylor is a freelance writer in Raleigh.
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