Dana-Farber Cancer Institute

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Every summer, Alyson Bierling, RN, clocks in for her shift on Yawkey 10. This is a world away from where she spends most of her time – Rwanda and Lesotho – as Dana-Farber‘s first oncology nurse navigator in the Center for Global Cancer Medicine (CGCM). Established in 2012, the CGCM, in tandem with Partners In Health (PIH), aims to reduce the global cancer burden in under-resourced settings by developing cancer care delivery systems that provide high-quality patient care. They also build capacity through teaching, professional development, and research. Several times a year, small groups within the CGCM travel to various countries – including Rwanda, Lesotho, and Liberia – to educate providers in cancer care and provide program support to strengthen capacity at local cancer centers. They also provide remote support for tumor boards and education series in Haiti. “In the countries where we work, awareness of cancer is limited but growing,“ shares Bierling, who joined the Institute in 2023. “The term ‘global cancer medicine‘ hadn‘t been widely used until the last 10-20 years.“ During the last 15 years, life expectancy in Africa has been increasing. While people live longer, the risk of cancer increases with age – and with added years comes a higher chance of developing cancer. In Africa, the focus has been on treating malnutrition in children or various infectious diseases in adults. It‘s common for clinicians to receive little to no formal training on how to identify cancer symptoms or treat patients with cancer. As an oncology nurse navigator, Bierling helps develop tools and resources and provides guidance on how to strengthen systems within the Rwandan Ministry of Health. She mentors new oncology nurses and advocates for improved staffing and safe environments for nurses. While Bierling has yet to travel to Liberia and Haiti, she says Rwanda and Lesotho are homes away from home. Before joining Dana-Farber, Bierling, who started her nursing career as a pediatric hematology-oncology nurse in her native Canada, was first hired by PIH as a senior oncology nurse educator who worked alongside Dana-Farber and CGCM colleagues in Rwanda. “When I was in Canada, I worked with patients who were refugees, and that‘s when I became interested in global health and health equity,“ recalls Bierling. “I knew that hematology-oncology was always going to be part of my career and that I wanted to be involved in working to reduce cancer disparities.“ More: https://lnkd.in/exBdGrJH ⬇ 1. Alyson Bierling (second from right) gathers with colleagues from Rwanda before administering trastuzumab, a drug previously unavailable in the country, to a local patient for the first time at the Butaro Hospital.   2. Pediatric oncology nurses partake in a baseline cancer training led by Alyson Bierling (third from left) and her colleagues in Butaro.

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A year of treatment with a medicine made of an antibody and chemotherapy drug has proven highly effective in preventing stage 1 HER2-positive breast cancer from recurring, a team led by Dana-Farber researchers has found. In a clinical trial involving 512 patients with the earliest stage of breast cancer that tested positive for the HER2 protein, 97% of those treated with trastuzumab emtansine (T-DM1) after surgery were alive and free of invasive cancer five years after treatment. The results, published in the Journal of Clinical Oncology, suggest that T-DM1 is a reasonable treatment approach for this stage 1 population, the study authors say. In conjunction with the trial, researchers looked for biomarkers of whether the cancer was likely to recur even after treatment with T-DM1. They found that patients with high scores on the HER2DX test – which weighs clinical factors and the activity of four genes within tumor tissue – had a greater risk of recurrence. "Patients with stage 1 HER2-positive breast cancer have recurrence rates of 5-30%. Post-surgical treatment with chemotherapy and the antibody trastuzumab, which binds to HER2, can significantly reduce the risk of recurrence in these patients. But the side effects can have a detrimental impact on patients' quality of life," says study lead author Paolo Tarantino, MD, of Dana-Farber and the University of Milan (Italy). "In this study, we evaluated T-DM1, which links trastuzumab to a powerful chemotherapy agent, for effectiveness and toxicity in this group of patients." The phase II trial, dubbed ATEMPT, enrolled 512 patients at cancer centers across the U.S. All had a stage 1 HER2-positive cancer, meaning it was small and without lymph node involvement. Three hundred eighty-four of the participants were treated with T-DM1 and 128 were treated with chemotherapy and trastuzumab. Investigators found that, five years after treatment, 97% of patients receiving T-DM1 had no evidence of cancer recurrence. The rate of clinically relevant toxicities was similar in both groups. However, patients in the T-DM1 group reported better quality of life, with less neuropathy, less hair loss, and better work productivity than those in the chemotherapy-and-trastuzumab group. “The ATEMPT trial has taught us that one year of T-DM1 after surgery for patients with a stage 1 HER2-positive cancer leads to outstanding long term outcomes, making it a reasonable treatment approach for select patients,” says senior author Sara Tolaney, MD, MPH. 

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Recent advances in the treatment of multiple myeloma, a cancer of the bone marrow, have extended and improved the lives of many patients, but those gains have not been distributed equitably. According to Dana-Farber research, Black and Hispanic people in the United States are more likely to have a precursor condition of multiple myeloma called monoclonal gammopathy of undetermined significance (MGUS) than white people. Black people are also twice as likely to be diagnosed with the disease and have not experienced the same survival gains over time as white people. Many factors contribute to these disparities. For instance, inherited risk factors may increase the chances of developing multiple myeloma in people of African descent. However, the differences in survival largely stem from systemic racism, which has resulted in many Black Americans living with lower socioeconomic status, having less access to high-quality medical care, and lower enrollment and inclusion in clinical trials. “Many new medications coming out that are very impactful in terms of improved survival,“ says physician Monique Hartley-Brown, MD, MMSc, of the Jerome Lipper Multiple Myeloma Center at Dana-Farber Brigham Cancer Center. “But it‘s almost as if these medicines are on a floating shelf that is out of reach for many people.“ Several efforts underway at the Institute aim to lower that shelf, so everyone can benefit from medical advances. For instance, outpatient access to CAR T-cell therapies and bispecific antibody therapies – which, in the past, required hospitalization – could bring these therapies into reach for more people, explains Hartley-Brown. In addition, Hartley-Brown is working to reach more patients by further learning about the potential uses of a novel drug for multiple myeloma called mezigdomide. The drug, which is not yet approved by the U.S. Food and Drug Administration and is only available in clinical trials, is an oral medication that interferes with the cereblon E3 ubiquitin ligase complex, an intricate intracellular protein system found in myeloma cells, and causes changes that result in killing the myeloma cells. In an early stage clinical trial led by Dana-Farber‘s Paul Richardson, MD, director of research at the Lipper Center, it showed great promise in patients who have relapsed and have not responded to treatment. Iberdomide, also a once-daily pill with a similar mechanism of action, also shows favorable treatment benefits to patients with advanced recurrent myeloma. “An oral drug is much easier for community oncologists to prescribe and offer to patients in rural areas or areas where patients have limited or no access to an advanced health care system or academic cancer center,“ states Hartley-Brown. To increase access to oral agents, Hartley-Brown is reaching out to physicians and cancer centers nationwide. The goal is to educate more physicians and patients about these medications and to expand clinical trial participation.

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Laurie H. Glimcher, MD, Dana-Farber Cancer Institute President and CEO, announced today that she will step down after 8 highly successful years, on October 1, 2024, and will assume the title of President Emerita. Benjamin Levine Ebert, MD, PhD, chair of Department of Medical Oncology and a world-renowned medical oncologist and researcher, was appointed by the Board of Trustees to serve as the next president and CEO of Dana-Farber effective October 1. The seventh president of Dana-Farber and the first woman to lead the organization in its 77-year history, Glimcher began her tenure in October 2016 with a relentless focus on improving outcomes for patients and accelerating cancer drug development. Dana-Farber is credited for playing a critical role in the development of 51% of all cancer drugs approved by the U.S. Food and Drug Administration over the past five years. “Eight years ago, I began this journey with a deep appreciation for the extraordinary research that emanated from Dana-Farber since its earliest days and the clinical excellence that Dana-Farber provides patients and families,” said Glimcher. “And now, as I reflect on my tenure, I am intensely proud of what we have achieved in providing world class care for our patients, leading in innovation and discovering new treatments and cures.” Glimcher will continue her pioneering cancer immunology research at Dana-Farber and build on her legacy of mentoring young cancer scientists. Read more here: https://lnkd.in/gn4Ekd77 Laurie Glimcher Benjamin L. Ebert, MD, PhD

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