Catherine Benson @bensonca
Activity by Catherine Benson @bensonca
Metastatic melanoma is known as “the cancer that gives cancer a bad name.” While melanoma makes up less than 2 percent of all skin cancer cases, it accounts for the vast majority of skin cancer deaths, according to the American Cancer Society. An estimated 73,870 new cases of melanoma will be diagnosed in 2015.
A Mayo Clinic clinical trial is combining two drugs to create a compound that specifically targets melanoma tumor cells. The drug Abraxane has unique packaging that insulates the chemotherapy drug paclitaxel, providing the drug safe passage through the body until it gets to the intended target.
Metastatic melanoma tumor cells have distinct protein markers called VEG-F. Abraxane is combined with anti-VEG-F antibodies that recognize and bind to the VEG-F proteins. The packaging dissolves in the body, releasing the chemo drug and killing the cancer cells. The animation below shows how the new compound precisely and safely delivers chemotherapy to tumors.
This new technology has the potential to be used in other cancers, immune system disorders and organ transplantation, as well. “Much of this is the subject of ongoing research, as we’ve now built nanoparticles that target B cell malignancies [and] breast cancer, as well as more potent nanoparticles that carry not only paclitaxel as the chemotherapy payload but cisplatin as well,” says Mayo Clinic’s Svetomir N. Markovic, M.D., Ph.D., one of the world’s leading melanoma researchers. “By adding different chemo drugs into the nanoparticle we can make the chemo payload more effective for unique tumor targets.”
Dr. Markovic discovered this therapy’s potential three years ago while running a clinical trial. He noticed that a group of patients treated with two drugs given in a particular way had far better results than other patients enrolled. “The delivery method changed the way the drugs interacted,” he says. “We were able to get enough of the medication in the right place—the tumor—and not contaminate surrounding tissue.”
In this new trial’s first year, just a handful of patients are being enrolled. But if the drug is proven safe and effective, Dr. Markovic says the U.S. Food and Drug Administration should give approval to expand to other patients and other drug combinations. Phase 1 is expected to be complete in the next 12–18 months, with the B cell malignancy targeting study to start in about 12 months.
Mayo Clinic, in collaboration with Baylor College of Medicine, is planning to sequence the DNA of 10,000 Mayo patients for 69 genes that can affect how the body metabolizes, transports and reacts to certain drugs. The gene variations observed that are known to influence drug response will be entered into each patient’s electronic health record and a drug alert will pop up when the prescription is written for a drug for which that patient might have an adverse reaction or require a special dose.
“All of us carry common variations in our genes that might mean we respond differently to drugs,” according to Richard Weinshilboum, M.D., Pharmacogenomics Program Director at Mayo Clinic’s Center for Individualized Medicine and the Mary Lou and John H. Dasburg Professor of Cancer Genomics. For example, most people express the CYP2D6 gene, which the body uses to metabolize codeine into morphine. However, some people don’t have the gene, which means codeine won’t reduce their pain. Other people have too many copies of the CYP2D6 gene and make too much morphine, which could lead to a life-threatening drug reaction that causes a patient’s breathing to become dangerously depressed.
Over the past four years, Mayo Clinic’s Center for Individualized Medicine has been adding drug-gene alerts to its electronic health records, but they weren’t specific to a patient. Instead, if a clinician prescribed one of 20 specific drugs, an alert would pop up recommending the physician consider testing the patient for a genetic variation.
However, for the 10,000 patients in this study, the alert would say, “Your patient has the genetic variant”—no additional testing would be required. Mayo will be able to analyze the results to evaluate the potential value of having the genomic information pre-emptively. The theory is that this critical information will help prevent life-threatening drug reactions and reduce health care spending.
Dr. Weinshilboum hopes that the results of the study will help to determine the value—medically and financially—of pre-emptive pharmacogenomic testing. “The speed at which this is happening is astonishing,” Dr. Weinshilboum said. “This is the aspect of clinical genomics that will have the greatest potential impact, earliest, for the largest number of people.”
This study builds on foundational research and experience gained through funding from the Pharmacogenomics Research Network, funded by the National Institute of General Medical Sciences at the National Institutes of Health — and from experience obtained via eMERGE, a national network organized and funded by the National Human Genome Research Institute that combines DNA biorepositories with electronic medical record systems for large scale, high-throughput genetic research in support of implementing genomic medicine.
The United States is facing a shortage of health care workers in the next few decades, as our population continues to grow and to age. The Association of American Medical Colleges predicts a doctor shortage of 46,000 to 90,000 physicians by 2025, and the Bureau of Labor Statistics projects that the U.S. will need 526,800 more nurses by 2022. The BLS also projects that health care support occupations will increase 28.1 percent from 2012 to 2022, which represents the fastest growth of any major occupational group. This can include home health aides, medical technicians and medical assistants.
To address this health care shortage and prepare for the future, Mayo Clinic is reaching out to high school students and their teachers and counselors to educate them about the array of health care professions and to help students identify and prepare for career paths that are right for them.
“Our Career Awareness programs aimed at the high school level move from exploration to confirmation,” said Guy Finne, manager of recruitment strategies at Mayo Clinic. “They give students opportunities to confirm that this is what they want to do. We have a system of programs that start at the seventh through ninth grade levels with career exploration for the masses. We get preliminary information to as many students as we can. For example, we have a classroom speaker program to send our experts out to partnering schools. As we work with them, some of them raise their hands (as being) interested in careers.”
Finne said the efforts are critical for Mayo Clinic long-term.
“Mayo Clinic’s success is directly connected to the skill, knowledge, passion and efforts of our workforce,” Finne said. “We want to do our part in making sure our local and regional talent is well informed of the career opportunities in health care in order to ensure that our future applicant pools are diverse, talented and see Mayo Clinic as an employer of choice.”
According to the College Choice Report by ACT, which administers the ACT college readiness exam, 24 percent of 2014 high school graduates who were surveyed planned to major in the area of health sciences and technologies (e.g., physicians, nurses, physician assistants, dentists, EMTs and physical and mental therapists). Only 4 percent planned to major in health administration and assisting (e.g., health services administration and medical and dental assistants).
By their second years of college, however, high school students who planned a career in health care administration/assisting were among the most likely to switch majors. Only 7 percent of students who had planned to pursue these fields actually declared a major consistent with their stated plans. But many of the students stayed in the health care arena, with 43 percent intending to major in health care administration/assisting but majoring in health sciences/technologies instead. On the flip side, only 16 percent of those declaring a major in health care administration/assisting had planned to do so, while 53 percent had originally planned to major in health sciences/technologies.
“Research shows that counseling activities in high school designed to affect career choice, exploration and planning can be effective. In particular, effective interventions include things such as written exercises allowing for the comparison of occupational information and for setting goals and plans. There are tools out there, such as ACT Profile, that students can access without cost which may provide them personalized data and valuable information that will really help match them to the career that makes the most sense,” said Wayne Camara, senior vice president of research at ACT.
Mayo Clinic also has partnered with Rochester Public Schools and Rochester Community and Technical College to open and provide ongoing support for the Health Science Careers Center.
“All enrolled students start with the Introduction to Health Sciences and then have the chance to specialize in the second semester in one of four areas: nursing assistant, pharmacy technician, therapeutic medicine or biomedical science,” Finne explained. “We know that those students who’ve participated were prepared for college because of the experiences they’ve had with our programs. A number who take part in the Health Science Career Center program leave high school having their certified nursing assistant credentials, and some put themselves through college that way. Many end up at Mayo.”
Mayo Clinic programs for high schoolers
Mayo Clinic has developed or partnered with several programs to educate students about the many different careers available in health care. These programs include:
Exploring-Learning for Life— a partnership with the Boy Scouts of America, the program provides a learning experience for high schoolers revolving around the goals of career exploration, life skill development, service learning experiences, character education and leadership opportunities.
Career Observation Program—intended to help confirm interest in health care career paths. Students receive information for career decision-making and insight into Mayo Clinic careers and Mayo Clinic as a potential employer.
High School Mentorship—brings students to Mayo Clinic to work with a mentor on an identified, specific project for a minimum of 60 hours. The program is intended for high academic performers to introduce them to career opportunities in a wide variety of biomedical science fields.
Health Occupation Students of America—a national career and technical student organization endorsed by the U.S. Department of Education. Nationally, there are more than 66,000 members. Mayo Clinic works with local chapters and supports them with classroom resources, on-campus tours and more.
Mayo Clinic Health Care Career Festival— offers high school students in Southeastern Minnesota the opportunity each October to explore a wide range of exciting career opportunities in a festive, engaging atmosphere. More than 900 students from 45 area schools (who apply to attend) participate each year.
Youth Apprenticeship—a paid experience in which a student works at Mayo Clinic for 400 hours in the summer between his or her high school junior and senior years and 400 hours during the student’s senior year. The opportunity is open to students enrolled in the Health Science Careers Center in Rochester, Minn.
Teacher Externship—a continuing education graduate credit course for five secondary career educators, health occupations educators and counselors for 40 hours over the summer. They work as a cohort, and the experience is hands-on. In the health care industry, Mayo Clinic realizes many students who express interest in health care careers are poorly informed about the variety of opportunities available. This program helps educators learn more so they can guide students.
Mayo Clinic Center for Innovation, Mayo Clinic Ventures and AVIA have issued the Mayo Clinic THINK BIG Challenge, a national competition offering awards totaling $100,000 for entrepreneurs with innovative ideas to transform the future of health and health care.
Entrepreneurs can apply for one of two $50,000 THINK BIG challenge awards in these categories:
This challenge will focus on healthy people staying healthy and explore areas such as eating healthy, enhancing well-being, monitoring risk factors and engaging in daily exercise.
I Am Not My Disease
This challenge will tackle the presumption that people are defined by their disease and explore areas such as access to health data, health literacy and behavior modification.
In addition, Mayo Clinic experts will guide winners for a year as they develop their concepts for market. Apply for the Mayo Clinic THINK BIG Challenge by Saturday, Aug. 15, at transformconference.mayo.edu/think-big.
The THINK BIG competition will culminate on Thursday, Oct. 1, in Rochester, Minnesota, at the Transform 2015 conference, a gathering of industry leaders exploring the future of health and health care. Finalists will compete on stage in a live presentation. A panel of judges will select the winners with input from the Transform audience using smartphone technology.