New cancer initiatives

When Jim Slater was a high school physics teacher in Fontana, he could not have known what proton therapy for cancer would bring to the world. As he progressed through medical school at Loma Linda University and his residency program, he became aware of both the potential and the challenges of radiation therapy in treating various kinds of cancer. He conceived the idea of using protons rather than regular radiation to treat cancer, thus avoiding the collateral tissue damage caused by X-rays. Engaging with experts in the design, construction, and implementation of the world’s first proton unit at Loma Linda University Health, Dr. Slater’s dream became a reality in 1990.

Now the James M. Slater Proton Treatment & Research Center at Loma Linda University Health has treated nearly 20,000 cancer patients, mostly with prostate cancer, with minimal side effects. But its impact goes beyond those cured of cancer. The reputation that Loma Linda University Health has garnered from this 30+ year endeavor is reaping benefits. Now personalized cancer therapy at the cellular level has started developing, and several of the organizations on the front line have invited Loma Linda University Health to be involved. Let me detail some of these initiatives we are now developing or considering.

CAR T cell therapy   The CAR stands for Chimeric Antigen Receptors, which are attached to and modify the T cells of our immune system. This technique involves drawing a sample of the patient’s blood, extracting the T cells which are principles in immune responses, and returning the remaining blood back to the patient. These T cells are modified in the laboratory by adding the Chimeric Antigen Receptor, and then infused back into the patient. They provide an attack mechanism at the cellular level to eliminate cancer cells. This therapy is currently primarily used for blood-based cancers like certain leukemias and lymphomas but is quickly moving towards treating solid cancers also. Loma Linda University Health recruited Dr. Abdel-Azim several years ago to develop the laboratory and resources to provide this type of personalized cancer therapy.

Theranostics   This unique word comes from combining the words Therapeutics and Diagnostics into one word and is a similar technique to what has been used for decades to treat metastatic thyroid cancer. It now describes the mechanism for another form of personalized cancer therapy. What is called a radiotracer contains a compound that has a proclivity or attraction for certain types of cancer cells and, when injected into the patient, will go to those cells only. It emits a small amount of radiation allowing these sites to be seen with special scans. This can confirm multiple metastasis sites, at the cellular level, that would not be seen with normal external scans. Then, for treatment, a radionuclide is attached to this same compound, goes to these same individual cells, and destroys them without damaging the surrounding cells. 

At the present time, this is available in the US for prostate and neuroendocrine tumors only, though work is being done to add additional cancer types. It is now clear that often when traditional treatments “fail,” like radiation or surgical therapies, it is probably because we didn’t see all these micro-metastases that had already spread. Theranostics can find these cancer cells, wherever they are, and eliminate them. Though each treatment takes a few hours only, this may require 2-6 treatment episodes over several weeks to completely remove all cancer cells.

BNCT   This stands for Boron Neutron Capture Therapy and is even more experimental but with great promise. A form of Boron called Boron-10 (which makes up 20% of naturally occurring Boron) is incorporated into cancer-seeking molecules and then injected into the patient. A clear benefit of this compound is that it can cross the blood-brain barrier that often keeps most chemotherapeutic drugs from being successful with brain tumors. The Boron-10-containing compound has an attraction for the tumor and successfully enters these cancer cells. Then this area is radiated with neutrons, which do not damage normal cells. When they interact with Boron-10, however, they create alpha particles which destroy the cells they are in. The alpha particles are short-lived and do not travel far, so normal cells around the cancer cells are not damaged. Because of Boron-10’s ability to cross the blood-brain barrier, this modality is particularly useful in glioblastomas and other cancers of the brain. This treatment modality requires the ability to incorporate Boron-10 into cancer-seeking molecules and also special equipment to deliver neutrons to the target areas.

Some of these options require additional research, clinical trials to prove their efficacy, and clinicians skilled in their utilization. Time and money are critical to fully develop each process. Loma Linda’s successful history with proton therapy has provided the experience to bring these new modalities to the patient. While CAR T cell therapy is already being established at Loma Linda, we are working with external companies to explore both Theranostics and BNCT as additions to our spectrum of cancer treatments.

These new opportunities will save lives and enhance the quality of life for so many people. I’m excited about what our upcoming developments will provide for people throughout the region. And I believe you are, too!

Sincerely,

Richard Hart, MD, DrPH
President
Loma Linda University Health

P.S.  I actually felt guilty suggesting you look up Plummer’s Mariposa Lily in my last President’s Notes.  I am sure most of you did not, so here is a picture from the top of Pisgah with my favorite flower pushing up a single stalk amid the Wild Buckwheat. Enjoy!