MedStar Health News

Leonardtown, Maryland — Children expect to share many memories with parents as they grow older. What they never plan to share? Diagnoses of cancer — or pre-cancer, in Janet Langley’s case.

Janet, 46, began experiencing stomach pains last summer. She saw multiple doctors to puzzle out what was causing them before arriving at the office of U.K. Shah, MD, board-certified gastroenterologist at MedStar Shah Medical Group. Dr. Shah ran multiple tests to ascertain the source of her discomfort.

“At the same time I was experiencing this, my father had similar symptoms,” said Janet, of Solomons. “He went in for a colonoscopy and found out he had colon cancer. I had a colonoscopy myself just to make sure that had nothing to do with what I had going on.”

Regarded by many adults as an uncomfortable but necessary rite of passage, colonoscopies are procedures in which a clinician uses a flexible instrument to examine images of the colon and rectum. This view can reveal swollen and irritated tissue, ulcers, and polyps — common growths involving the lining of the bowel.

An estimated 15 to 40 percent of adults may have polyps, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and most are not dangerous. However, some polyps will turn cancerous over time — and removing them can help prevent colorectal cancer, the second leading cause of cancer death in the United States.

Testing revealed a large polyp in the bend of Janet’s colon. Due to its location, it could not be removed during the colonoscopy or an additional procedure known as a polyp resection.

Janet was referred to Tushar Samdani, MD, colorectal surgeon at MedStar St. Mary’s Hospital. Dr. Samdani was simultaneously treating Janet’s father, J.C. Tubbs, for colorectal cancer.

For those at average risk, colorectal screenings are recommended to begin at age 50 by the U.S. Preventive Services Task Force. At 46, Janet — with no known history of colon cancer until her father’s concurrent diagnosis — would not have been flagged for testing.

Janet had surgery to remove the polyp in 2018. A biopsy confirmed it was an adenoma — a precancerous growth.

“If I had waited, it would have definitely been cancer,” said Janet. “And I feel very fortunate because I probably would not have followed up attempting to remove the polyp if my dad hadn’t been going through the same thing. I would have procrastinated, and it’s a good thing I didn’t.”

“Around 10 to 20 percent of patients who develop colorectal cancer have other family members who have had it. Patients with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at twice the increased risk,” said Dr. Samdani. “The risk is even greater if the relative was diagnosed when they were younger than 45, or if more than one first-degree relative is affected.

“It is important that patients with colorectal cancer or even precancerous (adenomatous) polyps inform their close relatives so that they can talk with their doctor about starting screening at an earlier age,” he continued. “With regular screening, colon cancer can often be found early when it is most likely to be treated successfully.”

Today, Janet and J.C. are both doing well. They will continue to undergo regular screenings to monitor any polyps that may develop.

“The colonoscopy itself was simple compared to the preparation for it,” said Janet. The cleansing process necessary to ensure a clear view during a colonoscopy can be challenging for patients, but Janet said the discomfort is “well worth it.”

“If I could convince somebody to just get beyond that preparation, the rest is just to breathe,” she continued. “It’s all worth it if you consider what could happen if you didn’t catch a problem in time.”

March is Colorectal Cancer Awareness Month. Visit MedStarStMarys.org/Colon to learn more about the risk factors for colorectal cancer, including recommended screenings.

The U.S. Food and Drug Administration’s approval today of atezolizumab (Tecentriq®, Genentech) in combination with chemotherapy for the initial treatment of extensive-stage small cell lung cancer (SCLC) marks the end of numerous failed attempts to improve survival for people with the deadly disease.

“This is monumental for lung cancer patients,” says Stephen Liu, MD, an oncologist at MedStar Georgetown University Hospital who specializes in treating lung cancer and co-led the clinical trial leading to today’s approval through the Georgetown Lombardi Comprehensive Cancer Center. “Atezolizumab allowed us to achieve what for we thought for decades was beyond reach: an improvement in survival for these patients.”

Small cell lung cancer makes up about 10 to 15 percent of all lung cancers in the United States.  Almost all people who develop small cell lung cancer have a history of smoking, and, according to the American Cancer Society only about six percent of people with the disease survive five years or more.

“Since the 1980s, our standard treatment for small cell lung cancer has been platinum-based chemotherapy. This regimen reliably provides an initial response that is often dramatic, but almost always short-lived,” says Liu.

The regimen of carboplatin, etoposide and atezolizumab was first explored in an investigator-initiated trial at Georgetown Lombardi in 2016. It soon gave way to the global phase III IMpower 133 trial. Liu and Leora Horn, MD, of Vanderbilt University Medical Center, served as co-principal investigators of the study.

Results were first presented by Liu at the World Conference on Lung Cancer in September 2018 and simultaneously published in The New England Journal of Medicine.

The international, randomized, double-blind, placebo-controlled trial, compared standard chemotherapy alone or given concurrently with atezolizumab, an anti-PD-L1 antibody. The addition of atezolizumab extended overall survival for a median of 10.3 months to 12.3 months without notably increasing side effects. As of now, there has only been about one year of follow-up so the full potential of atezolizumab is not yet known, Liu says.

“In the context of over 40 failed phase III clinical trials, the improvement in survival seen with atezolizumab represents an important achievement,” Liu says.  

 “As SCLC is an unforgiving disease,” says Liu, “our first attempt at treatment is often our only chance to impact the natural history of this highly lethal cancer.”

The National Comprehensive Cancer Network (NCCN) has added atezolizumab to its treatment guidelines as the preferred treatment for extensive stage SCLC.

 “With the addition of atezolizumab to chemotherapy, we have finally moved the needle in SCLC,” says Liu. “It is now our charge to build upon these results and ensure that the next major advance is not another 20 years away.”

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Disclosure: Liu reports having received advisory board/consulting fees Apollomics, AstraZeneca, Bristol-Myers Squibb, Celgene, Genentech, Lilly, Merck, Pfizer, Regeneron, Taiho, Takeda.

Click the video below to watch Dr. Stephen Liu talk about cancer of the lung, head & neck and explain why getting involved in clinical trials for these conditions can be of great benefit for some patients, regardless of the stage of their disease.

WASHINGTON – The first cancer patient to be treated as part of a CAR-T cell clinical trial at MedStar Georgetown University Hospital through Georgetown Lombardi Comprehensive Cancer Center is still in “complete remission” six months after receiving the treatment.

Daisy Diggs, 67, of Laurel, Maryland volunteered for the experimental treatment after a lengthy battle with stage-three non-Hodgkin lymphoma, a type of blood cancer. Following her diagnosis in 2015, the mother of two and grandmother of four developed several tumors that could not be eliminated with chemotherapy alone.

“I had tumors in my lymph nodes, hip, pelvis, neck and right kidney. They couldn’t get a handle on it,” Diggs says. “I’ve been getting chemo for two and a half years. Each time I would have some [tumor] shrinkage and then they would grow. I thought, ‘Well, the chemo isn’t working for me, let me try this.’ I’m glad I did. I see these T-cells as Pac-Men circulating in my body and eating up the cancer.”

“We don’t know if others will have the same or similar response or for how long the treatment will be effective,” says Pashna N. Munshi, MD, associate clinical director of the Stem Cell Transplant and Cellular Immunotherapy Program, a joint program between MedStar Georgetown and the John Theurer Cancer Center at Hackensack/Meridian Health.

“Still, hers is exactly the early result we had hoped for. The fact that she is still in complete remission six months after her CAR-T infusion signals a promising chance for a long-term remission for Ms. Diggs.”

“I feel great,” says Diggs. “I’m so relieved to receive this latest news. For me, the CAR-T cells were 100 times better than chemo in terms of how I felt during the treatment. I’m just so happy. I thank God and I thank Dr. Munshi.”

Diggs joined the phase 2 CAR-T cell (axicabtagene ciloleucel or KTE-C19) clinical trial to test its safety and effectiveness, which had only become available two years after her diagnosis of follicular lymphoma. Starting in the summer of 2018, she began receiving the experimental therapy, which uses her own immune system to destroy the cancer.

CAR-T cells are made in a medical lab using a component of the patient’s white blood cells. There, the patient’s natural, disease-fighting T-cells are genetically modified to express synthetic receptors that target proteins commonly found on the lymphoma cells.  About two weeks later, the patient receives lymhodepleting chemotherapy for three days and the CAR-T cells are then infused into the patient. Thereafter, the CAR-T cells are expected to attack the tumors. The goal is that the CAR on the T cells will bind to and kill cells that express CD19, a protein that is found on B-cell lymphomas.

“Once the CAR-T cell engages the tumor, it gets activated and proliferates multifold thereby eradicating the lymphoma rapidly,” says Dr. Munshi.

CAR-T cell therapy carries many risks. Patients can experience drops in blood pressure, high fevers, neurological problems and even death as the body reacts to major changes in the immune system.  For Diggs, the risks of the experimental treatment were outweighed by the potential benefit.

“While we’re very pleased with the results of Ms. Diggs’ treatment through this clinical trial, it’s important to remember that this is only a single experience of the 80 participants who will be enrolled nationwide. We have enrolled an additional five patients in this study here at Georgetown.  

“I had to meet all the criteria for this - go to the dentist, get all these tests done, biopsies,” Diggs recalls. “At first I was nervous because I didn’t know how it would turn out. They explained the risks and told me all the bad things that could happen. But I figured that nothing else was working and that whatever happens, happens but if it’s good, it’s going to be wonderful.”

Diggs has reported few side effects limited to only muscle pain. After her first PET scan in October, doctors could no longer find any evidence of cancer. In only three months, her tumors had disappeared.

Diggs has reported few side effects limited to fevers and muscle pain. After her first PET scan in October 2018, doctors could no longer find any evidence of cancer. In only three months, her tumors had disappeared. Her second PET scan in January 2019 also found no evidence of cancer.

“We’re giving it the ol’ one-two punch,” Diggs says. “I always say we’re shutting that party down. Now it’s hopefully going to be shut down for good.”

Axicabtagene ciloleucel, is approved by the U.S. Food and Drug Administration as Yescarta for relapsed/refractory diffuse large B-cell lymphoma, transformed follicular lymphomas and primary mediastinal B-cell lymphomas, but is not approved for low grade lymphomas (follicular lymphoma, marginal zone lymphoma) that this clinical trial tests.

Very common side effects include cytokine release syndrome with symptoms including fever, nausea, headache, rash, rapid heartbeat, low blood pressure, and trouble breathing. Most patients have a mild reaction, but sometimes, the reaction may be severe or life threatening. Anemia (lack of cells that carry oxygen) and neutropenia (a decrease in white blood cells) are also very common.

This clinical trial is sponsored and designed by Kite Pharmaceutical, a Gilead Company. Dr. Munshi occasionally serves as a paid scientific consultant for Kite Pharmaceutical.

For more information about this trial, please contact Julie Verna at 202-444-0960.

MedStar Heart & Vascular Institute Hosts National Heart Valve Disease Awareness Day Flagship Event to Increase Awareness about Heart Valve Disease

Washington, D.C., February 22, 2019 – In recognition of National Heart Valve Disease Awareness Day on Feb. 22, MedStar Heart & Vascular Institute hosted a flagship event at MedStar Washington Hospital Center to raise awareness about heart valve disease, which affects thousands of people in the Washington, D.C., area and millions nationwide.

MedStar Heart & Vascular Institute physicians, along with U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH and WebMD Chief Medical Officer John Whyte, MD, MPH, spoke at the event to discuss the importance of early detection and effective treatments available to repair or replace malfunctioning heart valves, often without open surgery.  

Heart valve disease involves damage to one or more of the heart’s four valves. While some types are not serious, others can lead to major complications, including death. Fortunately, heart valve disease can be successfully treated with valve repair and replacement, often using minimally invasive techniques. 

MedStar Heart & Vascular Institute is home to some of the latest technologies available for heart valve procedures. It was one of the earliest sites in the United States to test some of the advancements in the valve procedures.

“MedStar Heart & Vascular Institute has been the site for every major clinical trial, including testing the effectiveness of transcatheter aortic valve replacement, or TAVR, which is a minimally invasive procedure to replace a narrowed heart valve without surgery,” said Stuart F. Seides, MD, physician executive director, MedStar Heart & Vascular Institute. “We have performed more than 2,000 TAVR procedures and because TAVR is less invasive than open-heart surgery, patients recover faster and typically go home in two to three days, compared to a week for surgery.”

“We are the only provider within 50 miles of the greater Washington area that offers all of these latest treatments for heart valve disease. With all of the latest technologies available to us in the numerous trials, we have the capability to sometimes treat patients who are otherwise untreatable,” added Vinod H. Thourani, MD, chairman of Cardiac Surgery, MedStar Heart & Vascular Institute at MedStar Washington Hospital Center. “As always, the earlier in the disease that we start treatment, the more likely it is that patients can avoid surgery and prevent the disease from becoming severe.”

Heart valve disease can be there at birth, or develop from damage later in life from calcification, radiation to the chest, other cardiovascular diseases and conditions, or infection. It is estimated that as many as 11 million Americans have heart valve disease and each year, more than 25,000 people in the U.S. die from the disease. 

Watch the video of the Valve Disease Day kickoff event at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center or click here.

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About MedStar Heart & Vascular Institute:
MedStar Heart & Vascular Institute is a national leader in the research, diagnosis and treatment of cardiovascular disease. A network of 10 hospitals and 150 cardiovascular physicians throughout Maryland, Northern Virginia and the Greater Washington, D.C., region, MedStar Heart also offers a clinical and research alliance with Cleveland Clinic Heart & Vascular Institute, the nation’s #1 heart program. Together, they have forged a relationship of shared expertise to enhance quality, improve safety and increase access to advanced services. MedStar Heart & Vascular Institute was founded at MedStar Washington Hospital Center, home to the Nancy and Harold Zirkin Heart & Vascular Hospital. Opened in July 2016, the hospital ushered in a new era of coordinated, centralized specialty care for patients with even the most complex heart and vascular diagnoses.