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Medscape
01-07-2025
- Health
- Medscape
Emerging Themes in GI Oncology from ASCO 2025
This transcript has been edited for clarity. Hello. I'm Dr Mark Lewis, director of gastrointestinal (GI) oncology at Intermountain Health in Utah. I'm speaking from the 2025 ASCO Annual Meeting in Chicago, where we've seen some interesting new data in GI cancers. I always enjoy doing this kind of on-the-ground reporting, and the real reason I love coming to these meetings is, while it's wonderful to network with colleagues, there is true progress in our field that we can take back almost immediately to our clinics to help our patients. There are three themes in GI oncology that I've seen emerge at this meeting. One is the utility or not of circulating tumor DNA (ctDNA) in affecting treatment decisions. The second is the role of immunotherapy in GI oncology, and the third is, I think, a real triumph for targeted therapy in oncology. Addressing the first, and to be honest, most controversial point: Where are we with ctDNA in GI oncology, and most importantly, where are we with these assays in terms of how we counsel our patients? Sometimes what's most important about ASCO is trials that are arguably negative in their findings. This year, it really caught my attention that DYNAMIC-III sort of turned over the apple carton terms of ctDNA-informed approaches to colon cancer. The design of this study was looking at patients with stage III colon cancer and using a ctDNA-informed approach in a randomized fashion to see if we should be escalating chemotherapy in patients who have a positive ctDNA signal. The randomization was against the standard of care. For years, I think there has been a false binary between using modern ctDNA technology and our traditional clinicopathologic criteria. After all, the whole way we classify stage III colon cancer is based on TNM staging, so that remains the foundation. What we are trying to discern together, and especially together with our patients, is when it is appropriate for this technology to be layered on top of traditional clinicopathologic criteria and thus affect treatment decision-making. The takeaway from this trial for me, especially since recurrence-free survival was worse for the ctDNA-informed cohort vs the standard of care, was that this is a prognostic assay, but not necessarily predictive. Patients who have a ctDNA signal that is positive who had escalation of their adjuvant therapy did not seem to benefit from the addition of, say, irinotecan to a traditional fluoropyrimidine and platinum doublet. Interestingly, also, I think this study validated that roughly one third — maybe no more than 30% — of stage III colon cancer patients have a positive ctDNA signal. My takeaway, again, is we're sort of going back to the future. It was the MOSAIC trial that was published in June 2004 that established the current standard of care for how we approach adjuvant therapy in stage III colon cancer. Now, slightly over two decades later, we really have not made vast improvements in the field, and ctDNA is wonderful, but it is not entirely supplanting the understanding we've had since MOSAIC and since IDEA. Without getting too into the weeds, I'll also point out that I think the statistical design here was ambitious. The hazard ratio in this particular trial, DYNAMIC-III, was frankly suggestive of the fact the study might have been underpowered, enrolling just over 200 patients, whereas MOSAIC had over 2000 to reach its practice-changing conclusions. Watch out for upcoming studies such as CIRCULATE-US and NRG-GI008, which will again use ctDNA negativity to look at de-escalation and ctDNA positivity to look at escalation. Until that trial matures, I don't think this assay is actually going to change the standard-of-care approach to stage III colon cancer in the United States. The second point I'd like to make is about immunotherapy. I love the fact that when patients come to me, and I've been described before our first visit as a chemotherapy doctor, I can tell them that there's more to medical oncology than indiscriminate cytotoxicity. We are truly in the era where immunotherapy has a role to play in a variety of GI cancers. We heard at the ASCO plenary session that immunotherapy has a major role to play now in adjuvant therapy for stage III colon cancer with mismatch repair deficiency. The ATOMIC trial showed a significant 3-year disease-free survival benefit using atezolizumab along with traditional FOLFOX chemotherapy to help patients in the adjuvant setting. The MATTERHORN study showed the advantage of using durvalumab atop FLOT in the perioperative setting in gastric cancer. So two different GI histologies, but a huge role now for immunotherapy in this space. Finally, dealing with metastatic colorectal cancer, the maturation of CheckMate-8HW shows that the ipilimumab-nivolumab (ipi-nivo) doublet definitely has a role to play in the metastatic setting. This has been interesting because when I think about immunotherapy trials that have changed my practice, the one I keep coming back to is KEYNOTE-177. It was such a triumph at the time of its publication and remains so. What's sobering to realize, though, is that as more time has elapsed since KEYNOTE-177 matured, the 5-year survival rate of the pembrolizumab arm remains about 60%. Also, you might remember that the initial survival curve dipped below the chemotherapy arm before it plateaued and improved for immunotherapy. There are certainly some patients who need an earlier, more aggressive response. Enter ipi-nivo. What I like about this trial is that the ipilimumab dosing seems quite conservative, at 1 mg/kg, with four exposures to that agent before nivolumab continues by itself. That's appealing to those of us who have always had some reservations about using an anti-CTLA-4 approach. The very first time I ever used immunotherapy in any setting was during fellowship. It was 2011, and it was ipilimumab in the setting of metastatic melanoma. I watched in amazement as this patient's disease melted away, but at a dose then of 10 mg/kg, the endocrinopathy was significant. I also watched as my patient suffered from pan-hypopituitarism. For medical oncologists who are understandably tentative about anti-CTLA-4 as a mechanism, the question is always, is the juice worth the squeeze? Here, you do get a higher response rate from ipi-nivo than you would with nivolumab alone for patients who, say, might be on the verge of visceral crisis and need a faster initial response. Finally, I want to talk about targeted therapy. I think what was incredible about ASCO this year is realizing just how much progress we're making with BRAF -mutant colon cancer. We have known for a very long time that this mutation confers a worse prognosis, and we've often wondered whether it's appropriate to treat these patients sequentially or should we take the BREAKWATER-informed approach of giving them encorafenib, cetuximab, a fluoropyrimidine, and a platinum upfront — arguably a quadruplet. I think the answer from this meeting is a resounding yes— a doubling of median overall survival from 15 to 30 months by essentially frontloading all of the effective treatment and not trying to do it in sequential lines of therapy. You never get a second chance to make a first impression. Really, what this means is we have to know as soon as possible that we're dealing with a BRAF mutation. There are certain clinical phenotypes that we look for — more aggressive disease, carcinoembryonic antigen rising in the right colon — but this is proof, once again, that the oncologist without the pathologist is blind. I cannot take proper care of my patients without a fully biomarker informed approach, and I can't wait for these test results to come back. This study allowed for at least early exposure to FOLFOX alone while BRAF mutation results were maturing, but we really need to partner with a pathologist and understand metastatic disease in GI the same way we would understand it in metastatic breast cancer. There is not a single breast cancer oncologist I know who would try treating their patients without knowing estrogen receptor, progesterone receptor, and HER2 status. I think we are absolutely at the point in GI oncology where it should be unacceptable to treat our patients without knowing KRAS , NRAS , BRAF , and arguably HER2 status, and certainly mismatch repair or microsatellite instability status. The final targeted therapy triumph at this ASCO looked at DESTINY-Gastric04. DESTINY has been an interesting suite of trials looking at the role of trastuzumab deruxtecan in a variety of HER2-positive cancers. I vividly remember the plenary session several years ago where the data for DESTINY-Breast04 earned a standing ovation. I was one of those people who stood up as a GI oncologist because I could see how this was going to help patients with HER2-positive disease across various primary sites. What we learned at this meeting with the maturation of DESTINY-Gastric04 is this drug particularly seems to outperform traditional second-line therapies such as ramucirumab-paclitaxel. There are downsides. This drug famously (or infamously) causes interstitial lung disease in about 1 in 7 patients. It's also absolutely vital to re-biopsy at time of progression to ensure that the HER2 target for this antibody-drug conjugate is still there. HER2 heterogeneity remains something we haven't fully grappled with, but I find that my patients, when I explain the role of a targeted therapy, are generally willing to undergo another liver biopsy —if they understand the lock and key hypothesis between the HER2 mutation and a drug such as trastuzumab deruxtecan. To sum up, from ASCO 2025 for GI oncology, the three main areas I see of progress, at least in our understanding, are number one, circulating tumor DNA remaining prognostic, but likely not predictive at this point; number two, immunotherapy having a major role to play now in the adjuvant colon cancer setting as well as in perioperative gastric cancer management; and number three, targeted therapy with BREAKWATER really becoming, I think, the standard of care in the first line for BRAF V600E-mutant colon cancer and trastuzumab deruxtecan making a strong play for second-line therapy in HER2-positive gastric cancer. This has been Mark Lewis, the director of medical oncology for gastrointestinal oncology at Intermountain Healthcare, reporting for Medscape from ASCO 2025. Thank you.
Yahoo
13-06-2025
- Health
- Yahoo
Who needs a statin? New Intermountain Study compares prescribing recommendations based on traditional risk factors vs. coronary artery calcium scoring
MURRAY, Utah (ABc4 Utah) – A new study by researchers at Intermountain Health in Salt Lake City aims to determine the best method to screen and evaluate patients who are at risk of developing coronary heart disease to identify those who would benefit from statin medication to lower their cholesterol. Currently, cardiologists determine a patient's need for a statin medication based on traditional risk factors, which includes using the Pooled Cohort Equation (PCE) to determine their risk. The PCE method calculates coronary risk by assessing risk factors of age, sex, total and HDL cholesterol levels, blood pressure, and whether someone has diabetes and is a smoker. However, a new approach to determining risk and selecting a statin is the use of the coronary artery calcium (CAC) score, which is determined by taking a low-radiation dose image of the heart using computed tomography – a CT scan – to look for calcium deposits in plaques in the heart's coronary arteries. Which approach is more effective? The new study aims to find out. 'Our study is now fully enrolled with over 5,600 patients, and in this abstract, we wanted to look at baseline characteristics and differences in statin prescribing recommendations,' said Jeffrey L. Anderson, MD, co-principal investigator of the study and distinguished clinical and research physician at Intermountain Health. 'The question we want to answer is whether we can do a better job in selecting people who need a statin for primary coronary risk reduction by using the coronary artery calcium score, rather than just putting coronary risk factors into an equation,' said Dr. Anderson. 'That is, is it more effective to use direct imaging to assess evidence of plaque burden or a risk probability equation? That's what we're aiming to find out.' The new study was presented on March 29 at the American College of Cardiology's Annual Scientific Sessions meeting in Chicago. The research is part of CorCal Outcomes, a large, randomized clinical trial at Intermountain Health that is comparing the PCE versus CAC score guidance to initiate a statin prescription for patients for primary prevention of coronary heart disease. Since 2019, Intermountain heart researchers have enrolled 5,615 patients into the study, with patients having an average age of 64.1 years old, and 51.3% of the study subjects being women. 'This CorCal Outcomes study has been a systemwide, eight-year effort to complete enrollment,' said Dr. Anderson. Intermountain patients at risk of coronary disease were invited to enroll in the study, and those agreeing to participate were randomized into two groups: those assessed using the PCE or those evaluated using their coronary artery calcium score. Results of scoring by their assigned risk assessment tool were sent in letters to their personal physicians, including whether a statin was recommended based on a high-risk score. Patients in the two groups in the study were found to have very similar baseline characteristics. However, researchers found that the rate of statin medication recommendations were different. The study is expected to conclude in early 2026, at which time a comparison of outcomes, including deaths, heart attacks, strokes, and revascularizations during up to seven years, and an average of over four years, of follow-up will be made. For the enrollment phase, researcher found a recommendation to start a statin was made much more often based on the PCE. In the PCE group, 50.7% of patients were recommended a statin, with another 21.7% to be considered for one. By contrast, in the CAC group, only 22.3% of patients were recommended a statin. This large difference in statin recommendations appears to be explained by the strong influence of older age in recommending a statin by the PCE and, in contrast, the frequent finding of a zero or low CAC score in many older patients, leading to a no-statin recommendation in them. Knowing which score is most effective is important, said Dr. Anderson, so that physicians can get statin medication to the right people, and not prescribe statins to those who don't need it. This is especially important considering that statins entail costs and can have side effects, including muscle aches and an increased risk of diabetes. 'We know there's a huge difference in prescribing recommendations, and next year we are anxious to see the impact of these differences on outcomes,' said Dr. Anderson. 'These findings can have a huge impact on how we practice preventive medicine in the future and how many and whom we put on a statin or other lipid-lowering drugs.' Close Thanks for signing up! Watch for us in your inbox. Subscribe Now Sponsored by Intermountain Health. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Medscape
13-06-2025
- Health
- Medscape
Teamwork in Oncology Spotlighted at ASCO
This transcript has been edited for clarity. Mark A. Lewis, MD: Hello. I'm Dr Mark Lewis, director of Gastrointestinal Oncology at Intermountain Health in Utah. Joining me today is Dr Stephanie Graff, director of the Breast Oncology Program at Brown University Health's Cancer Institute, and co-leader of the Breast Cancer Translational Research Disease Group. Today, we would like to talk to you about the latest updates from the 2025 ASCO Annual Meeting. Stephanie, it's a true joy to sit down with you. I always look forward to ASCO. I sometimes explain to my patients that it's like the Super Bowl of oncology, and I don't think that's hyperbolic. It's the largest meeting of the year. One of the true advantages is getting to network with people like you, but also — I don't know about you — I get a real tangible sense of progress, and I often tell my patients, 'Listen, I'm going to go to this meeting. I don't want to over-promise and underdeliver, but I think there's a real chance that I'll bring back something new that might affect your care.' There are the big four tumor types in oncology, breast, lung, [gastro intestinal (GI), and genitourinary]. You practice above the diaphragm, and I practice below the diaphragm. As we might talk about in the Venn diagram, I think we overlap. I'm just curious what's exciting you at this meeting? Stephanie L. Graff, MD: In breast oncology, there's been a large amount of really exciting news. One of the ASCO plenary sessions, which we haven't heard yet, is SERENA-6, which will be looking at camizestrant with circulating tumor DNA (ctDNA). That'll be exciting. We're getting updates on overall survival with the INAVO120 regimen. We saw this morning that it improved survival, which is great. We also are going to be seeing data looking at trastuzumab deruxtecan in HER2-positive breast cancer in the first line and then other data looking at targeted therapies for things like PI3 kinase. Our first oral [abstract] PROTAC, Dr Hamilton presented today, also showed improvement in progression-free survival. Many things like that are exciting and certainly starting to change practice. Pembrolizumab and sacituzumab [are] changing practice in first-line metastatic triple-negative breast cancer. There's so much and it's a really great breast oncology ASCO. Lewis: I'm so glad to hear that. There are a couple areas I think that we definitely overlap. I'm curious to get your thoughts on ctDNA. My sense as a GI oncologist is that it is a very prognostic biomarker, but it is not always demonstrably predictive. My real reservation in using it, to be honest with you, is: Number one, I don't think it entirely supplants our traditional clinical pathologic understanding. For instance, as a GI oncologist, if I think someone has high-risk stage III colon cancer and their initial postoperative ctDNA is negative, I'm not entirely going to abandon my approach to their adjuvant therapy. Also thinking about it as a patient, we're sometimes telling these people that they have literal subclinical disease. You can make the argument, 'Well, why wait until cells aggregate to the point that you can see them as an actual tumor on a scan?' On the other hand, I worry sometimes about the psychological impact of ctDNA. As you said, we'll hear about SERENA-6 tomorrow. I think that's a really interesting study in the sense of letting patients be aware of emerging ESR1 mutations that are conferring resistance to aromatase inhibition. I'll be really curious to see the outcome of that study and whether that's a meaningful change for the patient, because I think we sometimes actually underestimate the psychological weight. Graff: It's interesting. In breast oncology, we've benefited from a wealth of patient advocacy, driving a wealth of progress, funding, and advancing science, which has been really beneficial in our field. We actually have done research looking at how the psychological impact affects how patients handle disease. I think that, historically, you can imagine a time in medicine when people thought, 'Oh, those sweet little girls, we shouldn't weigh them down with the worry about cancer.' That has borne out to not be true. When we think about telling people the results of a mammogram that needs additional imaging or biopsy, or that they have dense breast tissue or that their mammogram needs additional follow-up in 6 months, none of those things actually increase or decrease a patient's worry. Lewis: Interesting. Graff: What helps is just open and honest communication. I think what's more important is that we empower physicians and oncologists with the tools to actually understand what these tests mean and how to communicate effectively with patients about them. I think patients are going to be worrying about the fact that they have cancer. Good test or bad test, that patient knows the next test might not be the same. Good test or bad test, their cancer could have a different outcome down the roadway. They're going to worry. I don't have cancer and I worry. I worry about my kids. I worry about my house. I worry about the weather. We all worry. I think that just having the tools to explain what's going on is probably the most powerful thing that we can do. Lewis: That is such a wonderful anecdote to literal and figurative paternalism, and you're absolutely right. We already have these points of apprehension in patient care and diagnostics, and I think ctDNA potentially adds to that, but we can use the same methods of counseling that we've used for all these other tools. That's so well said. I also wanted to tell you — and I really, really mean this — that I view breast medical oncology as aspirational for the rest of solid tumor oncology. When you were mentioning trastuzumab deruxtecan earlier, one of my most vivid memories from ASCO meetings of any year was the plenary session where DESTINY-Breast04 was presented. I remember being part of the standing ovation for that trial, even though I don't treat breast cancer anymore, because I thought, 'Wow, we are really making progress in biomarker-driven care.' The other reason I view you as aspirational is we are not yet at that standard in GI oncology, at least, where it's a foregone conclusion that we would know all the biomarkers that we need to know. One of the interesting conversations I have with patients now is on pathologists as our silent, or at least unseen, partners. I think you would agree that you would almost never treat a patient with metastatic disease without knowing ER, PR, and HER2 status. Meanwhile, over in GI oncology, I'm sometimes having to ask for these things to be done that would be relevant to my patients, say KRAS mutations or BRAF mutations. To me, it seems like it should be as reflexive for me as it is for you as a breast cancer oncologist. What I'm getting at here, too, is this is back to how we have conversations with patients. I think patients need to understand, again, that biomarkers are a huge part of how we personalize their care, even though they might never actually meet their pathologists. Again, I just wanted to tell you, because I don't often get to sit with you, that the way that breast cancer oncologists — and to your own point, patient advocates — have kind of pushed things forward, it's a rising tide that lifts all boats. I often use your field as an example of where we should be. Graff: It's ironic because I have maybe the opposite perspective. As a breast oncologist, I feel like, here we are in 2025 with all these amazing genomic ctDNA and RNA assays, and we're still using ER, PR, and HER2, which is — spoiler alert — literally dumping ink on slides, right? It's immunohistochemistry. Our thoracic oncology colleagues are using true genomic-driven care to look at ROS1 , EGFR , and all these different things to say, based on this profile, this is what you're going to get. We're like, well, we have to wait for that ER to come back. I'm a little bit jealous that some fields have more genomic-driven care than breast does, but you're right. Breast was definitely a pioneer in biomarkers. DESTINY-Breast04 is an interesting example because, if anything, it shows that the biomarker doesn't matter, right? Trastuzumab deruxtecan is a HER2 antibody, and as it turns out, it works great for HER2-positive disease, but it also works great for HER2 not-so-positive disease. DESTINY-Breast06 now includes ultra-low, which is zero with just a little bit of fuzzy in the background. We're seeing that maybe we're not getting our biomarkers right after all. Lewis: So well said. I remember thinking about the effect in ultra-low and thinking, man, how strong is this bystander effect? If the chemo payload is being delivered to barely present HER2 receptors, it must be really potent indeed. I often think that we're actually putting a large amount of credence in what our pathologists tell us. For instance, like you said, immunohistochemistry is very qualitative, sort of semi-quantitative. Again, with things like PD-L1, it's funny how we all have sour grapes to other tumor types. Thinking about continuous variables, we can always debate the appropriate cutoff. Pathologists have actually warned us at this very meeting. I remember Anirban Maitra standing up and saying, 'Listen, you guys need to realize, as pathologists, the number that we give you for PD-L1 expression, for instance, that's our impression on that day, on that slide. You really shouldn't take it to be gospel truth.' Again, I think we're still finding our way with that. Graff: We've seen, in breast oncology, a presentation at this meeting looking at if that's the forefront for AI, right? Is that where artificial intelligence is going to be able to augment our ability, because again, we heard in the opening session that AI should be a tool that is an agent to advance human skills. If AI can help augment the eye of the pathologist, enhance the skills of the microscope, and move HER2 zero to HER2 ultra-low with more accuracy than the naked eye or more robustly in global centers where access to those stains aren't as readily available, then AI is advancing care for everyone equitably around the globe: the same global population that's participating in these trials and bringing them to our patient population. Back to biomarker-driven care, I think it just comes back down to patient communication. All of these tests take time. Even in breast oncology, sometimes my patients have to wait. They have to wait for ESR1 . It's a mechanism of resistance. I don't have it until their disease progresses and I can send that test out. That means that sometimes they have to have some patience while we wait and make sure that they're a candidate for the right therapy at the right time. That requires partnership with a bunch of people on my team. The staff that draw the blood and the mail room staff that ship it out to the right team. I'm so thankful that I have a huge wealth of people that make the cancer center work. Lewis: So well said. I often tell my patients that oncology is a team sport. Graff: Yes. Lewis: I think the last thing I wanted to say is that you and I have talked a little bit about the pace of progress as a wonderful problem to have. I'm curious, [going] off your comment about sort of global equity, how do you feel like that plays out in sort of clinical trial design? Graff: The breast oncology community discussed this today as some data were revealed. An interesting problem that we're starting to have in breast cancer is the rapidity of new agents relative to the rapidity of trial accrual. This means that, if it takes a year to design a trial and get regulatory approval, and then another year to accrue and then another year to read out results, by then there have been 27 new drugs added, right? I think we had 25 regulatory approvals last year in the US, or something like that, in oncology. Whatever the standard-of-care control arm was in the study 3 years ago when that trial was designed is laughable. I'm going to use the example of second-line HR-positive breast cancer. We have two problems. Problem number one is that the standard control arm is fulvestrant. When many of these trials were accruing in 2020 and 2021, that was the standard of care. Now, we have ESR1-targeting agents. We have PI3 kinase-targeting agents. We have data that extending a CDK4/6 inhibitor is efficacious. We have evidence for earlier trastuzumab deruxtecan for patients that maybe aren't so endocrine sensitive. We can always extend everolimus into that space. There's all this other stuff, including oral SERDs. There are so many different directions we can go. I don't even remember what all I've listed [to] at this point. We're getting the next generation of medicine, but they're still being compared to fulvestrant. Lewis: Right. Graff: We're looking at these results, saying, 'Well, great, you beat that drug we used back in the late 1900s.' Lewis: Right. Yes. Graff: Now, I think that another problem is that global angle, which is that not all of those new drugs, although almost all of these trials are global trials, they're accruing these from international countries. Not all of the regulatory agencies have approved them internationally. Not all of the payers have approved them internationally because they meet different benchmarks around the globe. Lewis: Yes. Graff: That standard-of-care arm isn't available as we advance. Again, trial design gets complicated because if we want the control arm to be the US standard of care, and that's different than the German standard of care, the Indian standard of care, the Kenyan standard of care, or the Argentinian standard of care; then we have to make sure that they're connected with that standard of care. We have to make sure that they're comfortable delivering that standard of care and figure out what that really looks like. Lewis: I think where I completely agree with you is you have to walk before you can run. It's really exciting to see the sophisticated assays like ctDNA, but I'm sitting here thinking, based on your comments, I can't even guarantee that I'll have mismatch repair protein status in my patients with colon cancer. Again, we have to take this in a stepwise fashion. You're right that, for all the excitement that we understandably and should feel at meetings like this, we do have to temper our enthusiasm a little bit and be practical in the real world. I have to say, Stephanie, it's just a delight to sit with you. I think you really are a true exemplar of shared decision making. Again, it really, at the end of the day, doesn't come down to the primary site. Yes, you're a breast oncologist. Yes, I'm a GI oncologist. A rising tide lifts all boats, and I think, as we also heard this morning, there's a difference between irrational exuberance and unjustified optimism, and then there's legitimate hope. At least what I feel at these meetings, and I strongly suspect you do too, is legitimate hope for our patients. Graff: I agree. Lewis: With that, we'll close. Again, thank you for joining us. We hope this was a helpful summary of what we've been hearing today at the ASCO 2025 Annual Meeting. Thank you.
Yahoo
06-06-2025
- Health
- Yahoo
Intermountain Health launches cancer treatment program for patients with advanced melanoma skin cancer
SALT LAKE CITY, Utah (ABC4 Utah) – May is Melanoma Awareness Month and Intermountain Health is unveiling an exciting new treatment program for Utahns with advanced melanoma cancer – the first time local patients have been treated with this advanced technology and new therapy in the Beehive State. Thanks to this new cutting-edge personalized cancer treatment program, Utahns who have advanced melanoma cancer no longer have to leave the state to get a groundbreaking new treatment that is showing promise for patients with the deadliest type of skin cancer. Intermountain Health has launched a new program to provide tumor-infiltrating lymphocyte (TIL) therapy to treat patients with a type of skin cancer called unresectable or metastatic melanoma that cannot be removed surgically or has spread to other parts of the body. It is the first time this therapy has been used to treat patients in Utah. This novel therapy works by using special immune cells, called lymphocytes, which are taken from the tumor itself. These cells are then multiplied in a lab and put back into the patient's body to help fight the cancer. As part of the treatment process, doctors use AMTAGVI, the first and only FDA-approved prescription medication for the treatment of advanced melanoma that has not responded to standard therapies. AMTAGVI activates the patient's own immune system to target and destroy cancer cells and represents a different approach compared to other immunotherapies. Instead of broadly stimulating the immune system, it harnesses a patient's own tumor-specific T cells to directly target and destroy cancer cells. Intermountain Health cancer experts say the groundbreaking treatment marks a significant advancement in the fight against advanced melanoma, offering a new option for patients with limited treatment alternatives. 'We're excited to offer this advanced therapy and the hope it provides for improved outcomes for patients who have not responded to standard therapies,' said Tawnya Bowles, MD, a surgical oncologist at Intermountain Health. 'The promise for patients is that this treatment will work against their advanced melanoma when other treatments have failed. These patients do not have as many treatment options once their tumor has progressed on standard treatments. This therapy offers new hope for these patients.' TIL therapy has been used for decades, but AMTAGVI allows the treatment to extend beyond select treatment centers by using a protocol that lets a patient's tumor T cells grow at centralized facilities in the United States. Previously, only limited academic facilities with lab facilities could grow and expand the T cells. For Utahns, having the therapy program available locally is a major advancement. Not only does Utah have the highest incidence of melanoma in the nation, but until now, Utahns needing TIL therapy had to travel out of state for their care. 'Each year we see Utah patients who need this next step of treatment for advanced melanoma, and these patients previously had to leave the state and incur the expense of travel and the increased stress of being away from home,' said Caroline Nebhan, MD, PhD, Intermountain Health medical oncologist. 'We're thrilled to be able to offer this advanced treatment close to home with our Intermountain Health oncology team.' Patients in the new Intermountain treatment program are supported by a multi-disciplinary team of clinicians, including oncology experts and patient navigators, who work closely with patients throughout their treatment. The therapy involves surgically removing a sample of the patient's tumor, from which tumor-infiltrating lymphocytes (TILs) are extracted. These TILs, which are immune cells capable of recognizing and attacking cancer cells, are then sent to a specialized manufacturing facility where they are expanded and multiplied into billions of cells. Once the manufacturing process is complete (approximately 34 days), the patient undergoes a short course of lymphodepleting chemotherapy to prepare their body for the infusion of the expanded TILs. Following the AMTAGVI infusion, patients may receive several doses of interleukin-2 (IL-2) to further stimulate the activity and growth of the infused T cells. Patients are cared for in the hospital for a period to monitor for potential side effects. Research results of the medication were promising. Clinical trial data supporting FDA approval of AMTAGVI demonstrated promising response rates and, in many cases, prolonged outcomes in patients with advanced melanoma, suggesting the potential for long-term control of the disease. 'We're committed to providing our patients with access to the most advanced and innovative cancer treatments,' said Dr. Bowles. 'The addition of AMTAGVI to our comprehensive oncology program underscores this commitment and offers new hope for patients battling advanced melanoma.' To learn more about cancer care at Intermountain Health, go to Close Thanks for signing up! Watch for us in your inbox. Subscribe Now Sponsored by Intermountain Health. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
31-05-2025
- General
- Yahoo
What it's like to live with sensory sensitivities
When Roger and Carrie take their family out for a fun evening, they always know the location of the closest exit. But it's not for the reason you might think. Their 13-year-old daughter Lily has autism and sensory processing disorder. This means her brain processes senses differently and some senses become overwhelming. Deseret News has agreed not to use the family's last name to protect the teen's privacy. Growing up, Lily was sensitive to taste, texture, sound and smell, which would affect the food she'd eat, the clothes she'd wear and the places she could go. According to her mom, Lily would 'know the smells I did not even know existed.' 'Helping Lily to feel safe has become a family project,' Carrie said. One in 36 children in the U.S. has autism spectrum disorder, which 'equates to about 25,000 children in Utah,' according to Intermountain Health. Sensory sensitivities are common in children with autism. A 2022 paper by University of Utah's Huntsman Mental Health Institute found that 74% of children with autism are affected by sensory sensitivity. That equates to 18,500 children in Utah based on the previous estimate. Sensory sensitivities can vary and are not associated with an individual's IQ, Dr. Deborah Bilder, one of the researchers for the paper, emphasized to the Deseret News. 'It's just a different way of experiencing aspects of the senses. It's not abnormal. It's not bad. It's not impaired. It's just different,' Bilder said. Some individuals are sensory avoiders, meaning it's harder for them to ignore sensory intake, according to Autism Speaks. This is called hypersensitivity. Someone who experiences hypersensitivity with bright lights, including the sun, could choose to wear sunglasses or a hat to help avoid a sensory overload. There is also hyposensitivity, which means individuals seek out sensory intake. That could look like someone spinning and needing to move. Per Autism Speaks, experiencing both hypersensitivity and hyposensitivity is common. 'It's really about finding that right balance for that person to be able to experience what they want to or need to experience,' Bilder said. On a family trip to Yellowstone National Park a few years ago, Lily's family was creative in how they helped her handle her sensitivity to smell. To help cover up the smells of Yellowstone, including the sulfuric fumes from the thermal pools, Lily's parents put Vicks VapoRub under her nose. Though VapoRub has its own strong scent, it's a familiar smell for Lily and would be more comforting than the strange smells of the park. The mask she was wearing due to the COVID-19 pandemic also helped, Lily said. In that moment, she said she was thinking, 'OK, I don't want to smell it. I don't want to fall off. Don't run. Don't push me. I just need to be on the path.' VapoRub is just one of the many ways Lily's parents, Carrie and Roger, have had to think outside the box to make the world a more sensory-friendly place for their daughter. Carrie keeps items such as Lily's favorite scented chapsticks, headphones and fidget tools in her purse. Taylor Swift's music has also been a helpful tool for Lily on hard days. 'Taylor Swift helps me get through it,' Lily said. Carrie added, 'Taylor's really doing more than she knows for our family.' When they go out, Carrie and Roger take separate vehicles and leave at different times. Carrie joked that that might make some people question the state of their marriage. 'Lots of times, we end up missing half of whatever we're going to because one of us will leave with her if it becomes too overwhelming,' Roger said. Carrie added, 'There are also family activities that we divide up for because we just know this will not be successful, but we have other kids that need experiences and need time together.' When Lily was younger, free early intervention and occupational therapy were helpful resources for the family as Lily was introduced to new exposures in positive and safe environments. But it's been difficult to find activities and events that are sensory inclusive for Lily and the rest of the family, Carrie said. 'I think that the sensory-friendly spaces exist. I don't think that a lot of people know about them, where they are,' she said. 'The challenge for me is that I don't know what exists, and I feel like we just kind of go it alone, you know? And sometimes we take a chance and we hope for the best, and other times, we just kind of say, 'I think we pass on that experience. I don't think it's gonna work out.'' Sporting events and plays heavily incorporate bright lights and loud sounds to create fun and engaging atmospheres. But those features could make it impossible for someone with sensory sensitivities to enjoy their experience. Multiple organizations are trying to create sensory-friendly events and spaces to make Utah more sensory inclusive for individuals like Lily and her family. Utah Valley University's Melisa Nellesen Center for Autism is one of those organizations. With partners in the community, the center organizes autism and sensory-friendly events throughout the year such as Quiet Santa and Moving Mountains soccer camp. They also collaborate with the Timpanogos Symphony and Orchestra every year for a special performance that leaves the lights on in the auditorium. UVU's Noorda Center also offers sensory-friendly performances for most of its children's plays. For communities to create more sensory-friendly events like these, Laurie Bowen, the director of the Melisa Nellesen Center, believes individuals with autism should be included in the planning process from the beginning. These events can be a great opportunity for families with children who have autism, but Carrie said, 'That exists only if you know about it, and if you're available on this certain day.' Bowen recognizes that and acknowledges that as a university, the center 'can't do all of it.' 'Our goal really is to make a community of belonging, and with that is arming other people with information so that they can also become part of that group that is addressing and assisting,' she said. One of the organizations that has stepped up to make more spaces and events sensory inclusive — including some that may have seemed impossible for someone who is hypersensitive to attend — is the nonprofit KultureCity. Husband and wife duo Dr. Julian Maha and Dr. Michele Kong founded KultureCity in 2014. A few years prior, Maha and Kong had taken their neurodivergent sons to a local museum in Birmingham, Alabama, when one of their sons experienced a sensory overload. They were asked to leave after their son started engaging in stimming behaviors to regulate his senses. Stimming behaviors are characterized by repetitive noises, movements and habits. That experience stopped Maha and Kong from daring to try new public experiences with their sons for years, KultureCity's Meg Raby Kinghoffer told the Deseret News. When one of their sons pointed out they never went anywhere, Maha and Kong organized a sensory-friendly night with the Birmingham Zoo. Their sensory inclusive vision grew from there and led to the creation of KultureCity. Utah has over 20 certified KultureCity venues with sensory rooms and/or sensory bags. A map of and information for each of the venues can be found on the KultureCity website and app. These venues include the Delta Center, the Clark Planetarium, the Discovery Gateway Children's Museum, schools, stores, libraries and even police departments. The Salt Lake City Police Department was the first police agency in the U.S. to be certified in KultureCity's sensory inclusive training, according to Kinghoffer. SLCPD officers now carry sensory bags in their patrol cars to assist individuals who may be experiencing sensory overwhelm. In those sensory bags, you'll find fidget tools, headphones to dull the loud sounds of their environment as well as a visual communications card and feelings thermometer for when an individual may be unable to verbalize their thoughts and feelings. Those items can be found in every KultureCity sensory bag. With KultureCity, Kinghoffer travels across the country for the nonprofit's activations and pop-ups, including the opening of the Salt Lake City International Airport's first of three sensory rooms in March and the NCAA women's basketball Final Four in Tampa, Florida, in April. In Tampa, not only was it special to see children benefit from the sensory bags and room, but Kinghoffer said it was 'really a beautiful thing when you see adults stepping up to request for the accommodations that they need, and seeing them just really kind of, in a sense, being seen and known in a public experience like that.' Businesses looking to become more sensory inclusive can reach out to KultureCity or the Melisa Nellesen Center for guidance. Bowen said the center exists to support autism and teach others how to as well. 'The whole reason we're here is to assist families and individuals with autism to get their needs met,' she said. Becoming sensory inclusive 'doesn't take much' and 'the impact is huge,' Kinghoffer said. The decision to do so will open the world up to more people with sensory sensitivities, like Lily. 'If people are not in this world, there's somebody you don't even think about. Something like a Jazz game is super amazing, and it's a little smelly — depending on who you're sitting next to — and (has) bright things. It doesn't have to be. There are ways to kind of change environments to make them more accessible, if we think about it, if we're aware,' Carrie said.
