Category Archives: In the News

Disparities in Breast Cancer

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October is Breast Cancer Awareness MonthOctober is Breast Cancer Awareness Month, and MSK experts have been speaking to news sources on topics related to this too-common cancer. This includes a recent piece from Today about disparities in breast cancer care for Black women.

In the United States, Black women are more likely to get diagnosed with breast cancer at a later stage and younger age than White women. They are also more likely to die from breast malignancies. MSK’s Dr. Elizabeth Comen describes how access to quality care remains inadequate for many, and how clinical trials for breast cancer treatments do not adequately represent Black patients.

Overcoming Resistance to Cancer Therapies, Nanomedicine and More

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Resistance to cancer therapy is one of the most challenging problems in oncology. Two recent papers report on new findings related to the phenomena of such resistance.

  • A UCSF team of researchers found that the presence of liver metastasis from any primary cancer causes resistance to immune checkpoint inhibitors therapy, specifically to anti–PD-1 immunotherapy. Using a mouse model, the scientists established a foundation for overcoming this resistance by combining anti-PD-1 with regulatory T cells targeting agents and thus restoring anti-PD-1 immunotherapy efficacy. The study was published in Science Immunology.
  • BRCA1/2 mutation-driven cancers, such as breast, ovarian, and prostate cancers, display high resistance to lifesaving therapies. Researchers from The University of Texas at Austin and Ajou University in South Korea identified a protein implicated in developing resistance to PARP inhibitors, a class of drugs that treat BRCA-deficient tumors. The study found that the low level of this protein, called PCAF, causes resistance to treatment with PARP inhibitors. The findings open the possibility of overcoming this resistance and increasing PARP inhibitors therapy’s effectiveness by combining them with a class of drugs called HDAC inhibitors, which boost PCAF. Research into PCAF protein, which has a role in chromatin modifications responsible for important DNA processes, contributes to the knowledge of cell replication and, therefore, to the understanding of disease pathophysiology. The study was published in Molecular Cell. 

In recent years, anti-cancer nanomedicine gained more and more ground. 

  • Researchers from two laboratories in Chicago conducted a recent study on nanotechnology that used charged nanoscale metal-organic frameworks (nMOFs) “for generating free radicals using X-rays within tumor tissue to kill cancer cells directly”. “Furthermore, the same frameworks can be used for delivering immune signaling molecules known as PAMPs to activate the immune response against tumor cells. By combining these two approaches into one easily administered “vaccine,” this new technology may provide the key to better local and systemic treatment of difficult-to-treat cancers”. This study was published in Science Advances. 
  • Yet another study on nanotechnology took a non-conventional approach to nanoparticle use. A research team from Singapore used a silica nanoparticle as a cancer drug, instead of a conventional drug carrier. The therapeutic nanoparticle caused cancer cells to self-destruct with the same efficiency as traditional cancer drug therapy in the lab mouse experiment. The researchers also “deceived” cancer cells, notoriously dependent on amino acids for their growth, by masking the therapeutic nanoparticle with an outer layer of amino acid L-phenylalanine. This research “may hold promise for the future design of nanotherapies” and “for cancer cells that have failed to respond to conventional treatment like chemotherapy.” The study was published in Small. 

More studies contributing to the knowledge of cancer biology were published recently.

  • Scientists from Rockefeller University in New York found that breast and lung tumor cancer cells can use blood vessels to gain access to a signaling pathway used by neurons. The tactics ultimately enable those cancers to metastasize. This research contributes to the knowledge of how cancers use or hijack normal cells and mechanisms to progress and establishes the foundation for new diagnostic and therapeutic approaches. The study was published in Nature. 

Addressing Ethical Questions at the Height of the Pandemic

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Liz Blackler

Liz Blackler, MBE, LCSW

Members of MSK’s Ethics Consultation Service recently reported on their experiences at the epicenter of the COVID pandemic in a JCO Oncology Practice article. I asked Liz Blackler, MBE, LCSW, a co-author and bioethicist who works full time on the Service, to tell me more about the article’s findings and the experiences of the Service in March and April, when requests for consultations more than doubled compared to the year prior.

MSK’s Ethics Consultation Service is made up of 10 consultants—psychiatrists, nurses, nurse practitioners, physician assistants, attending physicians, and social workers. These professionals, explained Ms. Blacker, “help mitigate [ethical] conflict in the hospital amongst staff and between patients and family members and their medical teams.”

“As a cancer hospital,” said Ms. Blackler, “we routinely manage end-of-life issues. We have a compassionate, empathetic staff who know how to handle these situations. But, in the midst of a pandemic, managing day-to-day care with no family at the bedside caused a lot of emotional distress for our staff.” Not only were they inundated by constant pandemic-related news, “they were living it day to day in the hospital.”

There were strict visitor restrictions. Staff often could not get in touch with family members of patients, and sometimes family members were also sick and unable to answer questions about care decisions. “There were real reasons why visitors were restricted,” said Ms. Blackler. “But in the setting of more PPE [personal protective equipment] and with more knowledge of how COVID is transmitted, we would want to lift or modify visitor restrictions.” Now, most patients can have one visitor.

Two issues arose that were new to the Ethics Consultation Service. The first was staff concern for their own safety. As Ms. Blackler related, “There was a level of staff distress, staff was worried about putting themselves at risk. This was early in the pandemic, when there were questions about transmission and the amount of PPE available.”

The second issue arose when patients wanted to leave the hospital. “All this was new for us,” said Ms. Blackler. “The issue was real—do we let patients leave against medical advice if we know they could potentially spread COVID to someone else?” In the end, the Ethics Consultants and medical teams encouraged patients to stay at MSK until a safe plan could be established or they tested negative for COVID.

The Ethics Consultation Service found new ways of offering support while working primarily offsite. Rather than waiting for consultation requests, Service members began offering virtual office hours twice a week for two hours at a time. “There was so much uncertainty. Just having a regular outlet was really helpful for staff,” said Ms. Blackler. “I would encourage other institutions to do that. It diffused issues before they became ethical conundrums and lowered the anxiety of staff.”