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Cancer Care Innovations: City of Hope uses genetics to fight cancer

Tabitha Paccione was 34 years old and in the best shape of her life.

So when her cough wouldn’t go away she just thought it was from the usual germs running around the first grade classroom where she taught in Downey.

This was December 2015.

Doctors gave her antibiotics but the cough persisted, so bad that sometimes she woke up gagging. Then her voice went hoarse and her back started aching.

It wasn’t until nearly a year later that a doctor figured out the problem: Stage-four non small cell lung cancer. Her prognosis: 3-6 months.

“By the time I was diagnosed the cancer was everywhere. All through my ribs. All through my bones. It was in my spine. I had several lesions on my brain, one on my liver,” she says, tearing up at the memory. “How could I have lung cancer? Lung cancer is for people who smoke. I never touched a cigarette.”

Her first thought was what would her two children do without their mother. Then a TV commercial popped into her head. It was for City of Hope.

“I remember seeing that when I was kid and thinking ‘Wow, what an amazing place,” she says. “So that was the first call I made.”

Paccione got an appointment with Dr. Ravi Salgia, chair of medical oncology and therapeutics research at City of Hope.

Dr. Ravi Salgia, chair of medical oncology and therapeutics research at the City of Hope in Duarte on Thursday, August 26, 2021. Dr. Salgia was among a team of international researchers who discovered a biomarker for a genetic mutation that causes about 5 percent of lung cancer. He then developed a therapeutic pill to treat the cancer.(Photo by Keith Birmingham, Pasadena Star-News/ SCNG)

Back in 2007 Salgia was among a team of international researchers who helped discovered a therapy to target a genetic mutation (ALK+) that causes about 5 percent of lung cancers.

Now fast forward to Paccione walking into his office at City of Hope. Salgia did a genomic profile on her — and bingo, she had the ALK+ mutation. He prescribed her the very pill that was developed from his reasearch.

“Within about a month of taking the pills the coughing stopped, I was able to sleep,” says Paccione.

Within three months, a scan showed her tumors had shrunk, the liver lesion was gone and her bones showed healing scar tissue where the cancer used to be.

Three years after starting therapy, the cancer was gone.

“I still kind of have to pinch myself when I say it,” she says.

Now five years cancer free, Paccione, who recently moved from Cypress to Houston, still takes eight pills a day. Her only side affects are occasional muscle pain and fatigue.

“But I’m here and I’m alive,” she says.

Dr. Edward Kim is Vice Physician in Chief of City of Hope National Medical Center and the Physician in Chief of City of Hope Orange County, which is building a premier cancer center in Irvine, set to open in 2022.

“Ten years ago I would have said Tabitha is a miracle,” he says. “Right now (her recovery) is what we hope to see and what we are seeing more of.”

Dr. Edward S. Kim, a renowned oncologist, is the new physician-in-chief for City of Hope Orange County. Kim will be instrumental in the development of what City of Hope plans as a world-class network of care in Orange County, anchored at its cancer care campus underway in Irvine. (Photo courtesy of City of Hope Orange County)

When Kim first started, back in the early 2000s, lung cancer patients were put on a generic chemotherapy regimen that was not tailored to the patient.

“We kind of just hoped it wouldn’t make you too sick and it would shrink the tumor,” he says.

It only worked, though, in 15 to 20 percent of the cases.

“And people got really sick,” Kim says. “Nausea, vomiting.”

Genomic profiling changed everything. Once researchers could identify the gene mutation responsible for a particular cancer, they could develop therapies to thwart it.

Currently eight biomarkers/therapies have been discovered for nearly half of the genetic mutations that cause lung cancer.

Unfortunately, not every lung cancer patient knows this.  It is estimated that only 50-70 percent of cancer patients around the country are getting tested for biomarkers by their doctors, according to Kim.

That’s costing a lot of people their lives. In 2021, lung cancer will kill nearly 132,000 American men and women — and as many as 20% of lung cancer patients are nonsmokers, according to the U.S. Centers for Disease Control and Prevention and the American Cancer Society.

“Every lung cancer patient should have a genomic profile,” Salgia says.

Earlier this month, City of Hope acquired Pacific Shores Medical Group, which has seven locations throughout Southern California, including Irvine, Huntington Beach, Newport Beach, Glendale, Torrance and Long Beach.

“We’ve grown our family,” Kim says.

And as part of the family, these health care providers now have access to City of Hope’s research opportunities, clinical trials and expertise.

“We’re going to learn from them; We have enough humility to know that delivering quality care is something they have been successful at,” says Kim. “But we can now empower these talented physicians with our depth of expertise. Our bench is full of experts who only focus on one particular kind of cancer. We eat sleep and breath cancer.”

City of Hope is also poised to open a second comprehensive cancer center in Irvine in late 2022. It is being touted as a destination center that is expected to draw patients from around the world.

For locals, it means more opportunities to receive highly specialized cancer care and participate in cutting-edge clinical trials — without having to travel far. Twenty percent of Orange County cancer patients currently go outside the county for their care, which can be a challenge, and even a deterrent.

“I truly believe that we have to provide opportunities to people closer to where they live, alleviating the burden on patients,” says Kim.

In addition to clinical trials and specialty treatments, the Orange County campus will have a research center where doctors will continue to hunt for more breakthroughs — and more biomarkers.

“It’s really due to the research that I can get to that next lily pad,” says Paccione. “Until we can find a cure, we’re just holding on and fighting.”

Source: Orange County Register

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