Cancer cells have secrets. And Dr. Gary Ulaner aims to unlock them.
Peering deep into the human body with a clarity traditional scans can’t match, molecular imaging can find tiny cancers that standard scans are blind to. The technology powering this uber-vision also can be harnessed to search out and destroy sneaky cancer cells where they hide — dangling the promise of more individualized and effective cancer treatments in the near future.
Hoag Memorial Hospital Presbyterian lured Ulaner from one of the nation’s best cancer research hospitals — Memorial Sloan Kettering Cancer Center in New York City — last fall with an irresistible pitch: Create the Hoag Molecular Imaging and Therapy Program and pursue what you think is vital. To that end, several clinical trials are now recruiting patients with prostate, breast and bone marrow cancer at the Newport Beach hospital — just as people have a newfound appreciation for what clinical trials can deliver.
“We got these trials going just in the first six months, and our goal in the next several years is to have a whole array of molecular imaging and therapy trials going to help patients with virtually every type of cancer,” Ulaner said.
Future is now
Nuclear medicine is considered the future of cancer treatment, and similar programs can be found at UCLA, UC Irvine, UC Riverside, Cedars-Sinai and many other hospitals.
But Hoag said it’s pioneering the most sensitive cancer detection and therapy methods yet developed, and bringing “exclusive” clinical trials to Orange County. Its bone marrow trial is the first of its kind in the nation, while its prostate trial is the first of its kind in the county, officials said. These trials are expected to play a significant role in the future of cancer detection, individualized treatment and drug development.
The principle behind this approach to America’s second-deadliest killer is as simple as envisioning a lock and a key.
“Every cancer cell has a protein and other molecules within and on the surface of the cell. I think of those as targets we can exploit. Those are our locks,” Ulaner said.
The key? “We can design molecules that specifically bind to those targets on the cell,” he said. “The key that fits into each of those locks.”
Next, a particle that emits low-level radiation is hitched to that key. It’s infused into a patient’s bloodstream and binds with cancer cells, if they exist.
Then the patient goes into a PET scanner — for positron emission tomography — and tumors that are invisible on regular imaging scans glow brightly on the computer screen.
“This allows us incredibly sensitive detection,” Ulaner said. “We can detect tumors one-tenth to one-one hundredth the size of what can be found on a CT scan. That makes a huge difference in planning the best course of treatment.”
One man had disease that appeared to be confined to the prostate. CT and bone scans found nothing beyond it, so surgery to remove part or all of the prostate gland seemed in order. But the patient had other risk factors and was scanned with molecular imaging — and Ulaner found that the cancer had already spread elsewhere. The patient wouldn’t have benefited from that surgery.
The beauty here, he said, is that the technology can not only find cancer, but treat it as well.
“Let’s remove that low-energy emitting isotope from the key and stick on something that emits a million times more energy,” he said. “Now we’re bringing that radiation right up against the cancer cell. We’re going to kill the cancer cell and, as long as nothing else has that lock, spare all the other normal tissues from dangerous radiation.”
More blunt agents, like chemotherapy, can damage healthy cells as well as cancer cells.
“This can be used on patients that have low-volume disease, and it also can be used on patients with high-volume metastatic disease that have failed other types of therapy,” he said.
Clinical trials
Thirteen of every 100 American men will get prostate cancer during their lifetime, and about two to three of them will die from it, according to the U.S. Centers for Disease Control. The most common risk factor is age.
Myeloma, also called multiple myeloma, is much rarer cancer of plasma cells. They grow too much, crowding out normal cells in the bone marrow that make red blood cells, platelets and other white blood cells. It affects about 35,000 adults a year and causes about 12,400 deaths.
Hoag is, or soon will be, recruiting patients for a breast cancer imaging trial, a prostate cancer imaging trial, a prostate cancer therapy trial and a myeloma imaging trial. More information can be found at bit.ly/3e3PmV1 and clinicaltrials.gov.
While science has been fixated on the COVID-19 pandemic for the past year, cancer killed far more people: 378,000 deaths from COVID-19 and 599,000 deaths from cancer, according to data from the Centers for Disease Control.
“The progress we’ve made on COVID has come precisely from these types of clinical trials,” Ulaner said. “When COVID recedes to the background in a year or two, cancer will remain.”
The molecular science used to fight COVID isn’t so different from how cancer researchers are using nuclear medicine, he said.
“If you look back a century, the leading killer of humans was infections. Then came the tremendous advance in antibiotics — a key fitting into a lock,” Ulaner said. “The antibiotic attacks a specific lock on a microorganism, and effectively makes it not a threat anymore.”
The goal of cancer research is to be as effective at the treatment of cancer as we were a century ago at the treatment of infection.
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