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New Study Examines if ‘Inoperable’ Pancreatic Tumors Can Be Safely Removed

The AHA! Team — Wed, 31 Jul 2024 08:06:36 +0000

University of Utah Health via Newswise – A clinical trial from Keck Medicine of USC aims to provide a surgical solution for patients with a form of advanced pancreatic cancer previously considered inoperable. The study will investigate if chemotherapy followed by a novel type of surgery to remove the cancer is a safe and effective option for patients with locally advanced pancreatic cancer, meaning that the cancer has not spread to other organs, but has grown into or close to nearby blood vessels that surround the pancreas. “Usually, these types of tumors cannot be safely removed with surgery because of the risk of damaging the blood vessels, which supply blood to the stomach, liver and other abdominal organs. However, due to recent advancements by Keck Medicine surgeons, we believe that patients with locally advanced cancer can be candidates for successful surgery, which could significantly improve outcomes,” said Steven Grossman, MD, PhD, co-lead investigator of the study. Grossman is a medical oncologist with Keck Medicine and deputy director for cancer services at USC Norris Comprehensive Cancer Center, part of Keck Medicine. The challenge of treating pancreatic cancer Pancreatic cancer accounts for only about 3% of cancers in the United States, but it is one of the deadliest. People usually have no symptoms until the cancer has become very large or metastasized throughout the body, so the cancer is caught late, and patients have poor prognoses. Only 13% of pancreatic cancer patients survive five or more years after diagnosis. The life expectancy of patients with locally advanced pancreatic cancer, which accounts for one third of all pancreatic cancer cases, has historically been about one year. For most forms of cancer, surgery is considered the most effective treatment for localized tumors that have not spread to other areas of the body. However, surgery has traditionally not been offered for tumors involving the blood vessels near the pancreas because if the blood vessels were to become damaged during the procedure, and the blood flow to organs interrupted, it could result in serious side effects or death. Therefore, typically the only treatment option for patients with locally advanced cancer is chemotherapy and/or radiation, both of which have limited effectiveness killing pancreatic cancer cells. “The situation is frustrating because research shows that in the rare cases where locally advanced tumors were safely removed, the progression of the disease was slowed and the patient’s length of survival on average increased from one year to 28 months, more than doubling life expectancy,” said Sandra Algaze, MD, a medical oncologist with Keck Medicine, a member of USC Norris and one of the study’s investigators. “Surgery, therefore, appears to strongly benefit a patient’s survival rate, which is why the medical field has been eager for a surgical solution.” How new surgical advances can benefit patients The clinical trial will use surgical protocols pioneered by Keck Medicine surgeons to safely remove locally advanced pancreatic tumors attached to arteries. The surgical team will be led by study co-lead investigator Yuri Genyk, MD, a hepatobiliary and pancreatic surgeon with Keck Medicine who is an expert in vascular reconstruction, which is the removal and reconstruction of blood vessels. Genyk has already successfully removed about 30 pancreatic tumors that were attached to adjacent arteries. “While this surgery is very complex, we have the skills and expertise to execute it and train other skilled surgeons in the procedure. If the trial results are positive, we envision that the technique could become the gold standard for how this stage of pancreatic cancer is treated in the future,” said Genyk. Patients in the clinical trial will first undergo chemotherapy to attempt to shrink the tumor. Two to eight weeks after completing chemotherapy, they will undergo a laparoscopic evaluation to determine the position and size of the tumor before the tumor is surgically removed and involved blood vessels are removed and reconstructed. Patients will be followed every three months for the first year post-surgery and then every six months for two years after that. The clinical trial will also examine if certain biomarkers, such as the tumor’s DNA, as well as a patient’s demographic factors such as age and gender, play a role in patient outcomes. The study hopes to enroll 20 patients with locally advanced pancreatic cancer who have evidence of arterial involvement by their tumors. The surgeries will be performed at Keck Hospital of USC. “Pancreatic cancer is a devastating diagnosis, and Keck Medicine is committed to finding better solutions for the disease,” said Grossman. “Anything we can do to improve patients’ quality of life and extend life expectancy will be a huge milestone that could benefit countless patients and their loved ones.” Those interested in participating in the study can contact: Charlean Ketchens, RN, at (323) 865-3035 or ketchensc@med.usc.edu. For more information about Keck Medicine of USC, please visit news.KeckMedicine.org. To read the original article click here.

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World’s First Partial Heart Transplant Proves Successful in First Year

The AHA! Team — Wed, 29 May 2024 08:13:15 +0000

Journal of the American Medical Assocation via Duke Health – Novel procedure demonstrated valve growth & functionality in newly published study results The world’s first partial heart transplant has achieved what researchers have spent more than a year hoping for DURHAM, N.C. – The world’s first partial heart transplant has achieved what researchers have spent more than a year hoping for — functioning valves and arteries that grow along with the young patient, as hypothesized by the pioneering team behind the procedure at Duke Health. The procedure was performed in the spring of 2022, in an infant who needed heart valve replacement. The previous standard of care — using valves that were non-living — would not grow along with the child, requiring frequent replacement, entailing surgical procedures that carry a 50% mortality rate. A study led by Duke Health physicians, appearing online Jan. 2 in the Journal of the American Medical Association, found that the new manner of valve procurement used during the partial heart transplant led to two well-functioning valves and arteries that are growing in concert with the child as if they were native vessels. “This publication is proof that this technology works, this idea works, and can be used to help other children,” said Joseph W. Turek, M.D., Ph.D., first author of the study and Duke’s chief of pediatric cardiac surgery, who led the landmark procedure. The study also found the procedure requires about a quarter of the amount of immunosuppressant medication than a full heart transplant, potentially saving patients from detrimental side effects that might compound over decades. Turek said the innovation has paved the way for a domino heart transplant, where one heart is able to save two lives. During a domino heart transplant, a patient who has healthy valves but is in need of stronger heart muscle receives a full heart transplant; their healthy valves are then donated to another patient in need, creating a domino effect. “You could potentially double the number of hearts that are used for the benefit of children with heart disease,” Turek said. “Of all the hearts that are donated, roughly half meet the criteria to go on to be used for full transplant, but we believe there’s an equal number of hearts that could be used for valves.” You could potentially double the number of hearts that are used for the benefit of children with heart disease “If you introduce the donated hearts that weren’t being put to use into the supply chain and add the valves from domino heart transplants, that can create a substantial change,” Turek said. The partial heart transplant procedure has been performed 13 times at four centers around the world, including nine at Duke, several of which have been domino heart transplants. Turek said bringing this innovation to a clinical trial would be the next step to achieving the volume in procedures that would change the availability of hearts by a large amount. “This innovation adds a lot to the whole donation community,” Turek said, “because it’s treating more kids, while also honoring the wishes of selfless donor parents who’ve given the ultimate gift. It allows them to offer hope to another child in the process.” Preclinical data was supported by the Brett Boyer Foundation. In addition to Turek, study authors include Lillian Kang, Douglas Overbey, Michael P. Carboni, and Taufiek K. Rajab. To read the original article click here.

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The Fight Goes On: Clinical Trial Shows Promising New Treatment for Rare Blood Cancer

AHA Publisher — Wed, 03 Jun 2020 07:00:26 +0000

Nagoya University via EurekAlert – Lymphoma is a type of blood cancer that develops from lymphocytes (a type of white blood cell). It has many subtypes. A rare subtype, called intravascular large B-cell lymphoma (or IVLBCL) is notably hard to diagnose accurately because the cancerous lymphocytes grow inside small blood vessels, instead of at lymph nodes, and there is no perceptible swelling/enlargement of lymph nodes. There is also no effective treatment: the disease tends to affect the elderly, for whom standard high-dose chemotherapy may have serious side-effects, and patients are at a high risk of developing subsequent central nervous system (CNS) disorders even with treatment. A novel treatment protocol with fewer side-effects and which also tackles secondary CNS involvement is needed, and this is exactly what a group of scientists, led by researchers from Nagoya University and Mie University, Japan, attempted to test in a new clinical trial. All of this being said, however, the rarity of this disease has made testing new combinations of drugs difficult. A previous “retrospective” study involving the analysis of medical records of patients who had undergone standard chemotherapy combined with a drug called “rituximab” showed that this line of treatment is more promising than standard treatment alone, but it does not solve the problem of secondary CNS involvement. “We considered that rituximab-containing chemotherapies combined with treatment for the secondary CNS problems could lead to further improvement in the clinical outcome,” remarks Dr Kazuyuki Shimada of Nagoya University. With this consideration, Dr Shimada and team conducted a Phase 2 multicenter clinical trial, where they administered their proposed treatment to 38 enrolled patients (aged 20 to 79 years and without CNS disorders at the time of cancer diagnosis) and monitored their conditions over the long term. The results are published in their paper in The Lancet Oncology Overall, their treatment protocol appears to be promising: 76% of the enrolled patients reached the primary goal of two-year survival without disease progression and 92% reached two-year overall survival. The disease affected the CNS in only 3% of patients. What’s more, the toxicity of the treatment was found to be low, and all adverse effects were manageable, with very few serious complications. Aptly summarizing their achievement, Dr Shimada says: “To the best of our knowledge, this is the first ‘prospective’ trial of any treatment in patients with IVLBCL. It appears that the proposed treatment protocol might be effective in patients without apparent central nervous system involvement at the time of diagnosis.” An important advantage of the proposed treatment protocol is that it employs a combination of conventional drugs and uses no novel agents. This means that although further study is necessary, this protocol can be adopted in clinical practice in the very near future. As Dr Shimada explains: “Given the rarity of this disease, a large-scale Phase 3 prospective trial is not feasible. In such a scenario, the results of our trial provide a safe and effective treatment option that can function as a historic control for future prospective trials.” The findings of this clinical trial are certainly quite promising. With only minor refinements to the proposed treatment protocol, patients with IVLBCL could have an edge in their fight against cancer. To read the original article click here.

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