Editor's note: This story was originally published in Health Care Quarterly, magazine about Southern Nevada's health care industry. Stories in Health Care Quarterly were submitted by doctors and their affiliates.
Murray Molinsky was diagnosed with cancerous tumors. He is a patient of Dr. Fadi Braiteh of Comprehensive Cancer Centers of Nevada.
Anti-cancer drug development has evolved over the last decade to further target the cancer cells’ molecular anomalies. Where research once focused on the anatomical location of a specific cancer (lungs, breasts, kidneys, gallbladder or the pancreas, for example), new studies are looking deeper within the cell to see what molecular anomalies are causing or driving a specific cancer, since each cancer has a specific “signature” or makeup unique to each patient.
The latest in clinical research is allowing us to accrue a patient with any cancer, as long as they have specific molecular mutations. They are then eligible for a trial called (and fittingly known as) signature studies. In medical circles these studies are often referred to as tissue agnostic studies or basket studies, because different cancers with similar molecular abnormalities of a same pathway are lumped together in the same “single basket trial” to be studied together.
Signature studies have only been available for the last three years — Comprehensive Cancer Centers of Nevada (CCCN) was one of the first sites in the country to get these studies alongside such major cancer centers as MD Anderson Cancer Center in Houston and the Mayo Clinic in Rochester, Minn.
CCCN is granted early access to new research, such as the signature studies, thanks in large part to its affiliations with The US Oncology Network as well as UCLA’s Jonsson Comprehensive Cancer Center. These studies are among the 170-plus trials CCCN conducts each year.
CCCN remains one of a very few community oncology practices in the country to have access to signature studies and currently has 11 of these studies open to patients, each focused on distinct genetic mutations, in collaboration with pharmaceutical companies such as Pfizer, Novartis, Seattle Genetics, and Genentech. While not all patients are eligible for these trials, those who have enrolled have benefited from stabilization of their disease growth. Some even become, and remain, cancer-free for more than three years.
A Sample Signature Study: Dovitinib (CTKI258)
Among CCCN’s current signature studies is the drug Dovitinib, which is reserved for patients with various genetic mutations. The drug is currently in development for numerous cancers and those diagnosed with various tumor types, including but not limited to bladder, cervix, liver, melanoma, pancreas and sarcoma.
The critical prerequisite for participating in the Dovitinib trial, as well as the other signature studies, is having the pertinent genetic mutation. At CCCN, once a prospective or current patient has been tested and verified as having the mutation, an oncologist determines his or her eligibility based on the patient’s health and ultimately customizes a treatment regimen.
Meet Murray
Murray Molinsky is a 67-year-old Las Vegas native, devoted husband of 44 years, father of two and grandfather of three. Molinsky’s battle with cancer began in 1992 when his physician found a cancerous tumor, the size of an egg, in his lower back.
He underwent radiation and his then-physician surgically removed the tumor. For five to six years after the surgery, Molinsky was cancer-free. During a routine check-up, his physician noticed that the cancer that was once in his back had metastasized to his lungs, where he had seven to eight new tumors.
Molinsky subsequently underwent a variety of different procedures, chemotherapies, radiation and five different clinical trials in Nevada and out-of-state, but the tumors kept coming back in larger waves. Amid several unsuccessful efforts over the years, Molinsky was told by several physicians that there was “nothing left that could be done” and his time left was limited.
After years without treatment, Molinsky visited CCCN experiencing a “13 on a pain level of one to 10.” He had four large tumors in his lungs that were growing at a very rapid pace and something needed to be done to stop their progression. Molinsky underwent a number of tests and was identified as having a rare genetic mutation, ESWR1 gene rearrangement.
Molinsky became one of the first patients in the United States enrolled in the Dovitinib (CTKI 258) trial and remains on it to this day. This is not a typical cytotoxic, or chemical, compound that poisons the cancer cells, but rather a compound to interfere with and block the growth, survival and division of cancer cells. While Molinsky’s tumors were growing fast at the time he started the drug in October 2012, Dovitinib has proven to “freeze” the cancer and keep it stable — essentially the tumor growth that once threatened his life, has halted, and he has seen significant improvements of his symptoms including pain. This drug has allowed Molinsky to live as normal of a life as possible, with minimal side effects, working part-time and planning various exhibitions with hotels throughout Southern Nevada. Where there once was little hope, stands a man who has endured doubt and put a stop to his cancer’s growth.
Signature studies, like Dovitinib, are a giant step forward in drug discovery; addressing cancers based on their molecular properties and not their geographic anatomy. With these studies, patients just like Molinsky are finding and embracing a new level of hope.