Tuesday, October 9, 2018
Open Board of Directors Meeting
Norton Event Center
1601 E. Third St., Suite 138
San Bernardino, CA 92408
Present: Patti Arlt, Deborah Barmack, Peter Barmack, Carole Beswick, Mark Cloud, Ken Coate, Kevin Dyerly, Sandra Espadas, Adam Eventov, Louis Goodwin, Otis Greer, Dick Hart, Mark Kaenel, Bill Lemann, P.T. McEwen, John Mirau, Dan Murphy, Roman Nava, Vikki Ostermann, Keven Porter, Brian Reider, Dan Roberts, Kristine Scott, Paul Shimoff and Ray Wolfe.
Guests: Catherine Pritchett and Arnold San Miguel.
Announcements: 1) Appreciation was expressed to the sponsors of the West End Reception held October 3, 2018 which was well attended. 2) The Executive Committee will hold a special meeting today at 4:00 p.m. at the Inland Action office.
M/S/P: Minutes from October 3, 2018
Kevin Porter introduced Dr. Richard Hart, President, Loma Linda University Health and Dr. Mark Reeves, Cancer Center Director, Loma Linda Health.
Dr. Reeves stated both the progress and the fight against cancer continues. Currently 1 in every 3 people will get cancer but the survival rate has increased dramatically. In 1977 the five-year survival rate was 49% compared to 69% in 2010. Despite the progress 610,000 people die annually from cancer and the number is growing. Heart disease has long been the country’s biggest killer, responsible for 630,000 deaths annually, but the numbers for this disease are dropping and deaths from cancer rising. By 2020 cancer will be the leading cause of death in the U.S.
A great deal of progress has been made through targeted diagnostics and therapies, immunotherapies, clinical trials and multimodal therapies. There are many targeted therapies now compared to the handful that were available just a few years ago. These therapies include imaging, molecular treatment, drugs, radiation and surgery.
Imaging now includes conventional imaging (CT/PET/MRI), molecular treatments like 68Ga-DOTATATE PET/CT for neuroendocrine tumors, and fused imaging such as UroNav effective for prostate cancer.
Some mutations from tumors can be seen on a molecular level, such as the BRAF mutation that’s seen in over 60% of melanoma cases. Genetic testing is valuable to identify high risk patients for cancer and liquid biopsies (a blood draw) are successful for disease monitoring in lung and other cancers. Pathway analysis is software used to identify related proteins within a pathway or building pathway de novo from the proteins of interest. Next generation sequencing (NGS) describe a DNA sequencing technology which has revolutionized genomic research. It can reveal abnormal pathways rather than using tissue samples and is very useful for diagnosing breast and lung cancer. Using NGS an entire human genome can be sequenced within a single day. These therapies can be used in many cases rather than a tissue sample.
Proton therapy has been extremely effective in both prostate cancer and liver tumors, among others. This type of radiation is specific to a targeted area. Often thought of as expensive, but the side effects of traditional chemotherapy and associated illness often leads to expensive hospital stays.
Targeted therapies have been created that only bind to cells or molecules that have cancer-specific changes or mutations. There are now just over 80 targeted therapies approved by FDA for treatment of cancer.
Robotic and minimally invasive surgery remains a good option for pelvic cancers. Many breast cancer surgeries have evolved to organ preserving surgeries due to new instruments and the difficult multivisceral resections needed in sarcomas are now much easier.
James Allison is an American researcher in molecular immunology and Nobel laureate. His discoveries have led to new cancer treatments. His studies found evidence that the immune system was prevented from attacking cancer cells due to antigens’ association with additional proteins. Finding the factors that inhibited the immune attack on cancer has been key to developing checkpoint-blockade cancer immunotherapies. These findings have completely revolutionized melanoma, lung and renal cancers. Cellular therapy such as CAR T uses T cells engineered for cancer therapy. These T cells are genetically engineered to express a specific CAR, which programs them to target an antigen that is present on the surface of tumors. For safety, CAR-T cells are engineered to be specific to an antigen expressed on a tumor that is not expressed on healthy cells.
Most advances in cancer care are due to clinical trials. The benefits of participation include cutting-edge therapies where many new drugs are available and helping the next generation of cancer patients. Unfortunately, less than 2.5% of adult cancer patients enroll in clinical trials. Childhood cancer now has an 85% 5-year survival rate greatly due to the more than 50% participation in clinical trials. With an annual budget of $50M, Loma Linda has some 75 open trials at any given time. The additional funding needed comes from patient revenue, grants, philanthropy and foundations.
The modern approach to cancer treatment is based on multimodality therapy and highly functioning multidisciplinary professional teams. Patients experience less duplication of services saving time and money and care paths they create are intended to improve patient outcomes and care delivery. Cancer care in the Southern CA market is highly fragmented and has separate contracting for various oncology services which erodes the needed multimodality therapy. For complex cancer care it’s important for all services to be available in same institution.
A Q & A period followed.
Meeting adjourned 8:30 a.m.